Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-6572

2. Registrant Information.

Registrant Reference Number: INRI-0233

Registrant Name (Full Legal Name no abbreviations): Bayer CropScienc Inc

Address: Suite 200, 160 Quarry Park Blvd SE

City: Calgary

Prov / State: AB

Country: Canada

Postal Code: T2C 3G3

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

20-JUL-15

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

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. 432-1516

Product Name: Esplanade 200 SC

• Active Ingredient(s)
  • INDAZIFLAM

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 352-846

Product Name: Perspective Herbicide

• Active Ingredient(s)
  • AMINOCYCLOPYRACHLOR
  • CHLORSULFURON

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 352-601

Product Name: Oust XP Herbicide

• Active Ingredient(s)
  • SULFOMETURON METHYL
    • Unknown

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Pasture fence line - Bare ground application of pipeline right of way

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Please refer to field 17 on 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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cow / Vache

3. Breed

nursing crossbred calf

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.4

7. Weight (provide a range if necessary )

Unknown

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

• General
  • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

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?

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

On July 1, 2015, (company name) applied a bare ground application of the pesticides listed above to a 3' X 12' fence line crossing an energy pipeline right of way. The fence line was part of a 200 acre pasture. On July 11, 2015, a 5 month old, nursing, crossbred calf was found dead. The calf was buried the day it was found dead and was never observed by anyone other than the rancher.

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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