Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2007-8710

2. Registrant Information.

Registrant Reference Number: 2007Nov04 Canada

Registrant Name (Full Legal Name no abbreviations): Monsanto Company

Address: 800 North Lindbergh Blvd.

City: Saint Louis

Prov / State: Missouri

Country: United States of America

Postal Code: 63167

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

16-NOV-07

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

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)

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

Product Name: Roundup WeatherMAX

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)
    • Unknown

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

Product Name: Roundup Original II

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Unknown

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

Product Name: Roundup UltraMAX RT

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Unknown

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

Product Name: RT Master

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Unknown

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7. b) Type of formulation.

Liquid

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting

• Cardiovascular System
  • Symptom - Abnormally low blood pressure

• Gastrointestinal System
  • Symptom - Other
  • Specify - Severe pancreatitis

• Respiratory System
  • Symptom - Difficulty Breathing

• General
  • Symptom - Death

• Blood
  • Symptom - Other
  • Specify - Culture septic shock

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Poisoning from ingestion of the pesticide

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Oral

11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

A man died after accidental ingestion of 1-2 ounces of a blue colored product said to be Roundup. Vomiting did occur, and the patient was admitted for observation. He was stable for about 12 hours, then deteriorated, required ventilator support, and ultimately expired with intractable hypotension (low blood pressure) and a diagnosis of "culture septic shock" and "severe pancreatitis." He had recently been diagnosed with diabetes and had a history of hypertension. It is hard to get an accurate measure on the amount of product actually ingested, so the 1-2 ounces may be an underestimate. The ingestion was from a soda bottle, brought home from a work site. The Washington Department of Health is still trying to track back to the farm and determine whether this is actually a Roundup product (or generic glyphosate) and if so, which product was involved. The patient evidently denied suicidal ideation, and the family and personal physician also believe that self injury was unlikely. Severe pancreatitis can cause virtually all of the problems seen in this patient, and thus the symptoms and death may have been unrelated to product ingestion.

To be determined by Registrant

14. Severity classification.

Death

15. Provide supplemental information here.

The Washington State Department of Health contacted the registrant trying to determine what Roundup product contained a blue dye. The case involves the ingestion of a blue colored product said to be Roundup. This could be Roundup WeatherMAX, Roundup Original II, Roundup UltraMAX RT, or RT Master (which does not carry a Roundup label). Therefore, each of these 4 products is listed in this incident report. If additional information becomes known to Monsanto, that information will be provided in a follow-up report.