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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-0539
2. Registrant Information.
Registrant Reference Number: 1285854
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.
18-NOV-135. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
Unknown
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. Unknown
Product Name: Unknown Bayer product
- Active Ingredient(s)
- FLUVALINATE-TAU
- Unknown
- IMIDACLOPRID
- Unknown
- TEBUCONAZOLE
- Unknown
- FLUVALINATE-TAU
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - In Home / Rés. - à l'int. 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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Himalayan
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
13
7. Weight (provide a range if necessary )
8.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Confusion
- Symptom - Disorientation
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
11/18/2013 Caller is a veterinarian treating a cat that developed anorexia and disorientation 3 days ago. An unspecified Bayer Advanced product was applied to a plant in the home in September 2013, and the cat was brought into the house in October 2013. The vet was only given the active ingredients in the product as the owner did not bring in the original bottle used. The litter box was placed near the plant 2 weeks ago. The owner could smell the product odor when pulling some of the leaves off of the plant, but no direct exposure was witnessed. The veterinarian thinks clinical signs are unrelated, but she told the owner she would double check as a precaution. An x-ray has been taken and blood test performed. Fluid was found in the abdomen, liver enzymes and creatinine are elevated, and the cat has hemolytic anemia, The veterinarian recommended a specialist which the cat will see tomorrow, and the cat is currently at home with the owner. 11/25/2013 Callback to the original caller for follow up information. Receptionist states that the cat died due to an underlying liver issue that they determined was unrelated to the plant product used.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
