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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-7511
2. Registrant Information.
Registrant Reference Number: 2100430
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-AUG-175. 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. 432-1518
Product Name: Specticle Flo
- 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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Boston Terrier
4. Number of animals affected
2
5. Sex
Male
6. Age (provide a range if necessary )
4
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
- Gastrointestinal System
- Symptom - Bloody vomit
- Symptom - Other
- Specify - Enteritis
- Symptom - Vomiting
- General
- Symptom - Death
- Symptom - Lethargy
- Respiratory System
- Symptom - Nose bleed
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
8/28/2017 Caller is from a veterinary facility who is calling to report a canine death and adverse signs in 2 dogs that live next door to each other. The owners of patient 1 reported that they had a lawn company apply a mixture of products to their yard on 8/24/2017. They kept their dog off of the lawn for 2 hours, as instructed by the lawn company, and then let them out. After 3 hours, the dog started vomiting and became lethargic. The dog came in to the veterinary facility this morning, and died on arrival with blood coming from the mouth and nose. Patient 2 is the owner's neighbor who reports that their dog vomited once this morning. The dog is not there yet, but is on the way. 8/31/2017 Call back to the original caller for follow up information. A necropsy is being performed on patient 1. So far, the only thing that has been found is enteritis. Patient 2 stayed at the clinic fro the entire day, and was sent home the evening of 8/28/2017. No further symptoms developed at the clinic. No treatments were done. Blood work was performed, and all results were within normal limits. The veterinarian spoke to the owner this morning, and the dog remained asymptomatic.
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Mixed Breed
4. Number of animals affected
2
5. Sex
Female
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
55.00
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
12. How long did the symptoms last?
>30 min <=2 hrs / >30 min <=2 h
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
Fully Recovered / Complètement rétabli
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
8/28/2017 Caller is from a veterinary facility who is calling to report a canine death and adverse signs in 2 dogs that live next door to each other. The owners of patient 1 reported that they had a lawn company apply a mixture of products to their yard on 8/24/2017. They kept their dog off of the lawn for 2 hours, as instructed by the lawn company, and then let them out. After 3 hours, the dog started vomiting and became lethargic. The dog came in to the veterinary facility this morning, and died on arrival with blood coming from the mouth and nose. Patient 2 is the owner's neighbor who reports that their dog vomited once this morning. The dog is not there yet, but is on the way. 8/31/2017 Call back to the original caller for follow up information. A necropsy is being performed on patient 1. So far, the only thing that has been found is enteritis. Patient 2 stayed at the clinic fro the entire day, and was sent home the evening of 8/28/2017. No further symptoms developed at the clinic. No treatments were done. Blood work was performed, and all results were within normal limits. The veterinarian spoke to the owner this morning, and the dog remained asymptomatic.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
