Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-1439

2. Registrant Information.

Registrant Reference Number: 04102012-JGTF

Registrant Name (Full Legal Name no abbreviations): Joint Glyphosate Task Force, LLC

Address: 8325 Old Deer Trail

City: Raleigh

Prov / State: NC

Country: USA

Postal Code: 27615

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

Scientific Study

4. Date registrant was first informed of the incident.

5. Location of incident.

6. Date incident was first observed.

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. 2004-0175      EPA Registration No.

Product Name:

  • Active Ingredient(s)
    • GLYPHOSATE

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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 VII: Scientific Study

1. Study Reference

Title A Pubertal Development and Thyroid Function Assay of Glyphosate Administered Orally in Intact Juvenile/Peripubertal Male Rats

Date 10-APR-12

2. a) Is an extension needed to translate the document?

No

3. Type of incident identified in the study

Presence of a component or derivitive

4. Describe the incident identified in the study (e.g. study demonstrates an increased risk to non-Hodgkin's Lymphoma after exposure to pesticide X)

There were no treatment-related effects at the lower dose levels of 100 or 300 mg/kg/day. A test substance-related delay in the mean age at attainment of balanopreputial separation, lower reproductive organ weights (epididymides, seminal vesicle with coagulating gland, and ventral prostate), and a lower testosterone level were noted in the 1000 mg/kg/day group. These changes were considered to be a consequence of the lower mean body weights in this group, typically reflective of anticipated general overt toxicity at the maximum tolerated dose for this assay.

5. a) Was the study discontinued before completion?

No

5. b) Provide the reason for discontinuation

6. If the study is ongoing, what is the expected completion date?

10-APR-12

For Registrant use only

7. Provide supplemental information here