Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-5195
2. Registrant Information.
Registrant Reference Number: 2456008
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.
06-JUN-19
5. Location of incident.
Country: UNITED STATES
Prov / State: SOUTH CAROLINA
6. Date incident was first observed.
04-JUN-19
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. 432-1544
Product Name: Temprid FX
- Active Ingredient(s)
- BETA-CYFLUTHRIN
- Guarantee/concentration 10.5 %
- IMIDACLOPRID
- Guarantee/concentration 21 %
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. - In Home / Rés. - à l'int. 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
Other
2. Type of animal affected
Other / Autre
specify Exotic
3. Breed
Hamster
4. Number of animals affected
1
5. Sex
Unknown
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?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Death
- Symptom - Lethargy
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
6/6/2019 Caller is from a pest control company. The product was properly diluted and applied at customers house on 6/4/2019 as a spot treatment. The product was applied inside the house, including the living room the hamster cage was in. The wall the hamster cage was on was not treated. After application, the owner reported that they did allow the hamster out of the cage to run around, and caller is not sure if the product was dry before this or not. Shortly after this, the hamster started acting out of sorts and was moving very slowly. Within 24 hours on 6/5/2019, the hamster suddenly died.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
The product was heavily diluted prior to use in this case and would have a wide margin of safety in mammals, including hamsters. If ingested, which is unknown if occurred, minor GI upset may occur but death is not expected.