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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1881

2. Registrant Information.

Registrant Reference Number: 1335236

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.

17-FEB-14

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

17-FEB-14

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. 72155-96

Product Name: 12 Month Tree and Shrub Protect and Feed - Granules II

  • Active Ingredient(s)
    • CLOTHIANIDIN
      • Guarantee/concentration .275 %
    • IMIDACLOPRID
      • Guarantee/concentration .55 %

7. b) Type of formulation.

Granular

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

Cat / Chat

3. Breed

DLH

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

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

  • Cardiovascular System
    • Symptom - Tachycardia
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Respiratory System
    • Symptom - Panting
  • Gastrointestinal System
    • Symptom - Foaming at mouth
  • Respiratory System
    • Symptom - Respiratory distress
  • Gastrointestinal System
    • Symptom - Abdominal distension

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Original call on 2/17/2014. Caller applied the product to her yard 90 minutes ago. Caller's cat was in the house during application, and came outside about 30 minutes later. The cat was seen laying in the area and digging. The cat was found panting, salivating, and ataxic soon afterward. The cat was taken to the veterinarian and vomited once on the way. The veterinarian reports the cat presented foaming at the mouth, with elevated heart rate, and in respiratory distress. The cat is now receiving intravenous fluids. Follow-up call on 3/27/2014. The owner stated that the cat was doing well for the first two days with treatment from the veterinarian. Two to three weeks later, the owner states the cat was exposed to the product again in an area they were not previously aware of. The owner was unable to elucidate further on how they determine the cat was re-exposed. The cat was found in the morning and had died. The cat had dried foam on the mouth and the stomach looked distended. They took the cat to the veterinarian, but by the time they arrived the residue was gone and the stomach was no longer distended. No necropsy was performed to determine cause of death.


To be determined by Registrant

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

Death

19. Provide supplemental information here