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Consumer Product Safety

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-13

5. 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

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?

Yes

Subform 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

19. Provide supplemental information here