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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0536

2. Registrant Information.

Registrant Reference Number: 1268444

Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.

Address: 295 Henderson Drive

City: Regina

Prov / State: SK

Country: Canada

Postal Code: S4N 6C2

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

21-OCT-13

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

08-AUG-13

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 72155-32

Product Name: Fire Ant Killer RTU Dust (1 lb)

  • Active Ingredient(s)
    • CYFLUTHRIN
      • Guarantee/concentration .5 %

7. b) Type of formulation.

Dust

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

9.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • General
    • Symptom - Anaphylactic shock
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Hypothermia
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

10/21/2013 Caller applied the product on an unknown date in mid-August. Caller's dogs were kept out of the area during application and for several days after. Caller witnessed one dog sniffing in the area on 8/30/2013, but did not witness any direct exposure. About 2 hours later, the dog became lethargic, vomited twice, had diarrhea, and fell over outside. The dog was taken to the veterinarian 2 hours later, and the veterinarian stated that the dog had anaphylactic shock, unknown liver changes, and decreased temperature. The dog's heart stopped, and resuscitation was attempted but was ineffective. A second dog in the home developed vomiting and diarrhea on 8/7/13, and anorexia on 8/9/13. The dog was evaluated by an emergency veterinarian on 8/10/13. No diagnosis was made, and dog was given an unknown injection for treatment. Vomiting subsided, but diarrhea and anorexia persisted. The dog was taken to the regular veterinarian on 8/12/13, and unknown blood work was performed and the dog was diagnosed with kidney disease. The dog was discharged with subcutaneous fluids, an unknown medication, and a special diet. The dog continued to decline, and died on 8/29/13.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Shetland Sheepdog (Sheltie)

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

40.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • General
    • Symptom - Death
  • Renal System
    • Symptom - Renal failure

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

10/21/2013 Caller applied the product on an unknown date in mid-August. Caller's dogs were kept out of the area during application and for several days after. Caller witnessed one dog sniffing in the area on 8/30/2013, but did not witness any direct exposure. About 2 hours later, the dog became lethargic, vomited twice, had diarrhea, and fell over outside. The dog was taken to the veterinarian 2 hours later, and the veterinarian stated that the dog had anaphylactic shock, unknown liver changes, and decreased temperature. The dog's heart stopped, and resuscitation was attempted but was ineffective. A second dog in the home developed vomiting and diarrhea on 8/7/13, and anorexia on 8/9/13. The dog was evaluated by an emergency veterinarian on 8/10/13. No diagnosis was made, and dog was given an unknown injection for treatment. Vomiting subsided, but diarrhea and anorexia persisted. The dog was taken to the regular veterinarian on 8/12/13, and unknown blood work was performed and the dog was diagnosed with kidney disease. The dog was discharged with subcutaneous fluids, an unknown medication, and a special diet. The dog continued to decline, and died on 8/29/13.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here