Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-1505

2. Registrant Information.

Registrant Reference Number: 1633670

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.

24-JUN-15

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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. 28837      PMRA Submission No.       EPA Registration No.

Product Name: LIBERTY 150 SN HERBICIDE (CANADA)

• Active Ingredient(s)
  • GLUFOSINATE AMMONIUM

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PMRA Registration No. 27598      PMRA Submission No.       EPA Registration No.

Product Name: CENTURION EMULSIFIABLE CONCENTRATE POSTEMERGENT HERBICIDE (CANADA)

• Active Ingredient(s)
  • CLETHODIM

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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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Field

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

Cow / Vache

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

300.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Unknown/Inconnu

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

6/24/2015 Caller sprayed these products on a field on 6/17/2015. There was some drift into a nearby pasture, perhaps 3 feet. There are 15 cows and 10 calves grazing in the area. Two days ago in the evening, two of the calves became sick. One calf has mild diarrhea, and the other calf has diarrhea, lethargy, and unsteady gait. The other 23 cattle are asymptomatic.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cow / Vache

3. Breed

Mixed Breed

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 )

300.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Muscle weakness
  • Symptom - Abnormal gait
  • Specify - unsteady gait

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Unknown/Inconnu

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

6/24/2015 Caller sprayed these products on a field on 6/17/2015. There was some drift into a nearby pasture, perhaps 3 feet. There are 15 cows and 10 calves grazing in the area. Two days ago in the evening, two of the calves became sick. One calf has mild diarrhea, and the other calf has diarrhea, lethargy, and unsteady gait. The other 23 cattle are asymptomatic.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here