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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-0869

2. Registrant Information.

Registrant Reference Number: 2126512

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.

16-OCT-17

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

15-OCT-17

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. 432-763

Product Name: Suspend SC

  • Active Ingredient(s)
    • DELTAMETHRIN
      • Guarantee/concentration 4.75 %

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

75.84

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Confusion
    • Symptom - Muscle weakness
    • Symptom - Seizure

12. How long did the symptoms last?

Persisted until death

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

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

10/16/2017 Caller sprayed diluted product in his yard yesterday morning. Caller's dog was not allowed to enter the application site until 4 to 5 hours later. The dog had a seizure 4.5 hours after dog was allowed into the area that lasted 4 to 5 minutes. The dog was weak and disoriented after the seizure. The dog had a second seizure 2 hours later that lasted 4 to 5 minutes and was more severe. No therapies were provided at home and the dog was immediately transported to an emergency veterinarian. The veterinarian placed an intravenous catheter, but is unsure if any therapies have been provided. The dog often has open wounds on his skin due to allergies, and caller bathed the dog immediately prior to allowing him in the yard. 10/18/2017 Attempted call back to the original caller. A message was left requesting follow up information. 10/21/2017 Call back to the original caller. The dog died at the clinic the day of the original call. Caller is unaware of any new signs developing or treatments performed prior to death. The veterinarian was not sure what the cause was for the signs that developed.


To be determined by Registrant

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

Death

19. Provide supplemental information here