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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-7168
2. Registrant Information.
Registrant Reference Number: 1715287
Registrant Name (Full Legal Name no abbreviations): Bayer CropScience Inc.
Address: 160 QUARRY PARK BLVD. SE Suite 200
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.
05-NOV-155. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
05-NOV-15Product 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. 30687 PMRA Submission No. EPA Registration No.
Product Name: RAXIL PRO CONCENTRATE SEED TREATMENT FUNGICIDE (CANADA)
- Active Ingredient(s)
- METALAXYL
- PROTHIOCONAZOLE
- TEBUCONAZOLE
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
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?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cow / Vache
3. Breed
Simmental
4. Number of animals affected
3
5. Sex
Female
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
1400.00
lbs
8. Route(s) of exposure
Oral
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
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Muscle tremors
- Symptom - Recumbent
- Specify - Down animal, unable to rise
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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
11/5/2015 Caller reports that three cows escaped from their pasture, wandered into his shop, and were licking around the product. Caller reports that the cows may have been exposed to something else in the shop, but he found them by the area where the seed treater was located. The incident occurred 2 hours ago. The cows are laying down and full body shaking. During the call, caller's veterinarian with him confirmed that all three cows were deceased. The veterinarian did not have time to attempt any treatments since their symptoms progressed quickly. 11/12/2015 Call back to the original caller to see if a necropsy was performed. A message was left requesting follow up. 11/17/2015 Call back to the original caller to see if a necropsy was performed. A message was left requesting follow up.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
