Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-5131

2. Registrant Information.

Registrant Reference Number: 1853690

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.

28-JUN-16

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

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. 72155-5

Product Name: All in One Lawn Weed & Crabgrass Killer Concentrate

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration 3.18 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration .78 %

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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: 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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

32.00

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 - Salivating excessively
  • Symptom - Vomiting

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Symptom - Seizure

• Skin
  • Symptom - Erythema

12. How long did the symptoms last?

Persisted until death

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

Yes

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

6/28/2016 Caller is a veterinary technician at a clinic treating a dog that developed in the last 2 to 3 hours difficulty standing, several episodes of vomiting, and 2 focal seizures lasting a few seconds. The pet owners applied the product on 6/25/16 and diluted product as instructed. The dog was no in the treated area until after the product had dried and it has rained since the product was applied. The dog is known to eat grass. Owner brought the dog to the clinic 2.5 hours after symptoms began. The dog has been given intravenous fluids, intravenous atropine, and a single dose of intravenous diazepam. Blood pressure and blood glucose were normal. Blood work showed blood urea nitrogen was high at 30, alanine aminotransferase was high at 547, amylase was low at 322, lipase was high at 1980, potassium was low at 2.3, and platelet count was low at 113 with no evidence of clumping. The skin around the dog's mouth is red and the dog was drooling. 7/2/2016 Call back to the original caller for follow up information. Veterinary technician would only say that the dog died on his own at the clinic on 6/28/2016.

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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