Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-0032

2. Registrant Information.

Registrant Reference Number: 1421979

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.

12-JUL-14

5. Location of incident.

Country: UNITED STATES

Prov / State: OKLAHOMA

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 72155-31

Product Name: Complete Insect Killer for Soil Turf Ready to spread Granules 10

• Active Ingredient(s)
  • CYFLUTHRIN
    • Guarantee/concentration .05 %
  • IMIDACLOPRID
    • Guarantee/concentration .15 %

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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

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

6

5. Sex

Female

6. Age (provide a range if necessary )

0.25

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
  • Symptom - Vomiting

• General
  • Symptom - Death
  • Symptom - Lethargy

12. How long did the symptoms last?

Persisted until death

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

No

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

7 12 2014 Caller applied the product to the yard on 7 10 2014. Caller placed the granules into the yard the evening of 7 10 2014 and did not water the product as they were expecting rain. It did not rain as expected, but instead rained on the morning of 7 11 2014. Caller has 6 puppies that were allowed back into the treated yard on 7 11 2014, and the caller believes the yard was still wet from the rain when the puppies were out. Caller left early in the day on 7 11 2014, and returned at midnight. Caller found 1 puppy dead when he returned home, and it is unclear if she experienced any symptoms. Three other puppies were weak, unable to stand, and not interested in food or water. Two of those puppies died 30 minutes later, and the third died just prior to the call. The other two puppies are lethargic and vomited all food and water offered. The puppies were found in a box on the side of the road approximately 6 weeks ago, and received only one dose of a 7 way vaccine from a farm supply store that was administered by the caller approximately 5 weeks ago. No professional or other veterinary care was given as the caller lives in a very rural location and does not have easy access. Any previous history is unknown, but the caller reported that all the puppies were quite thin when found. Caller reports that all of the puppies had gained weight and appeared healthy up to when the caller left the home on 7 11 2014. 7 13 2014 Callback to the original caller for follow up information. The two remaining puppies died about an hour after the original call before an after hours clinic could be found.

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To be determined by Registrant

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

Death

19. Provide supplemental information here