Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2021-0840
2. Registrant Information.
Registrant Reference Number: 2692992
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.
14-JUN-20
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
14-JUN-20
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. 30102
PMRA Submission No.
EPA Registration No.
Product Name: Raxil Pro
- Active Ingredient(s)
- METALAXYL
- Guarantee/concentration 6.2 g/L
- PROTHIOCONAZOLE
- Guarantee/concentration 15.4 g/L
- TEBUCONAZOLE
- Guarantee/concentration 3 g/L
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Mixed Breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
11
7. Weight (provide a range if necessary )
10
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
- Nervous and Muscular Systems
- Symptom - Muscle weakness
12. How long did the symptoms last?
Unknown / Inconnu
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?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
specify The dog rolled on an area where the product had been spilled 2.5 weeks previously.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
6/14/2020 Caller reports that product was spilled outside 2.5 weeks ago. Caller's dog rolled over the area 3 hours ago. The product was well dried, but they did have rain last night. About 30 minutes ago, the dog became very lethargic then vomited and had diarrhea. The dog was bathed at home.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here