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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-0623

2. Registrant Information.

Registrant Reference Number: 1243989

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.

10-SEP-13

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

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: Bayer Advanced (non-specific)

  • Active Ingredient(s)
    • CARBARYL

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. - 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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Nova Scotia Duck Tolling Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

45.40

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Eye
    • Symptom - Miosis
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Salivating excessively
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Muscle twitching
  • Renal System
    • Symptom - Polyuria
  • Nervous and Muscular Systems
    • Symptom - Shaking

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Fully Recovered / Complètement rétabli

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

9/10/2013 Caller is a veterinarian treating a dog that developed hypersalivation, shaking, vomiting, diarrhea, and slightly constricted pupils about 5 hours ago. The owners have no idea what the dog may have been exposed to and there was no witnessed exposure, but they suspect the dog went into the neighbor's garden that was treated with the product. 9/19/2013 Callback to the original caller for follow up information. The pet was asymptomatic at discharge on 9/11/2013 except for increased urination. They checked a urine sample which was normal, and the dog was not sent home with any treatments.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here