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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-2787

2. Registrant Information.

Registrant Reference Number: 2009678

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.

22-MAR-17

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Specticle

  • Active Ingredient(s)
    • INDAZIFLAM

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Cock-a-poo

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

5

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
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - sedation
    • Symptom - Other
    • Specify - inability to masticate

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

3/22/2017 Product was applied as pre-emergent treatment of the lawn at the customer's residence on numerous occasions, most recently being on 10/31/2016. The customer's dog died on 11/6/2016. Product was applied at 4 ounces per acre instead of the recommended 6 ounces per acre. It is unknown how the dog may have been exposed to the product and when. It is also unknown when the dog started to experience symptoms and when treatment was sought. A provided statement from the treating veterinarian states that despite diuretic therapy, oxygen support, and aggressive medical care, the dog passed away. She is strongly suspicious that the dog's death is the result of acute and chronic exposure to the product. At home the dog showed symptoms of muscle tremors, sedation, and inability to masticate. She feels that the dog would not have died without exposure to the product. Specific treatments, lab values, tests, past medical history and physical exam results are not provided.


To be determined by Registrant

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

Death

19. Provide supplemental information here