Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-2867

2. Registrant Information.

Registrant Reference Number: 1757939

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.

20-JAN-16

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

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. 2217-579-72155

Product Name: Triple Action Lawn Fertilizer plus Weed Control 48 lb

• Active Ingredient(s)
  • 2,4-D (PRESENT AS ACID)
    • Guarantee/concentration .69 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration .06 %
  • MECOPROP P-ISOMER (PRESENT AS ACID)
    • Guarantee/concentration .15 %

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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

Bird / Oiseau

3. Breed

Chicken

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

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?

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

1/20/2016 Caller found 5 of her 6 chickens eating out of a bag of the product this morning, and the other chicken deceased. The chickens were locked up overnight, and let out first thing this morning. The chickens have had access to the bag for a month, and caller doesn't remember looking to see if it had been opened in the past. The chickens are lethargic, 2 of them are not moving at all even when roused, and only one of them came out when feed was offered. They are egg laying hens, previously in good health, and taking no medications. The veterinarian has not been contacted. 1/26/2015 Attempted call back to the original caller. A message was left requesting follow up information. 1/29/2016 Attempted call back to the original caller. A message was left requesting follow up information.

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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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Bird / Oiseau

3. Breed

Chicken

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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

• General
  • Symptom - Lethargy
  • Symptom - Hesitancy to move

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1/20/2016 Caller found 5 of her 6 chickens eating out of a bag of the product this morning, and the other chicken deceased. The chickens were locked up overnight, and let out first thing this morning. The chickens have had access to the bag for a month, and caller doesn't remember looking to see if it had been opened in the past. The chickens are lethargic, 2 of them are not moving at all even when roused, and only one of them came out when feed was offered. They are egg laying hens, previously in good health, and taking no medications. The veterinarian has not been contacted. 1/26/2015 Attempted call back to the original caller. A message was left requesting follow up information. 1/29/2016 Attempted call back to the original caller. A message was left requesting follow up information.

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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

Bird / Oiseau

3. Breed

Chicken

4. Number of animals affected

3

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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 - Lethargy

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1/20/2016 Caller found 5 of her 6 chickens eating out of a bag of the product this morning, and the other chicken deceased. The chickens were locked up overnight, and let out first thing this morning. The chickens have had access to the bag for a month, and caller doesn't remember looking to see if it had been opened in the past. The chickens are lethargic, 2 of them are not moving at all even when roused, and only one of them came out when feed was offered. They are egg laying hens, previously in good health, and taking no medications. The veterinarian has not been contacted. 1/26/2015 Attempted call back to the original caller. A message was left requesting follow up information. 1/29/2016 Attempted call back to the original caller. A message was left requesting follow up information.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here