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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2010-3713

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: 100080324

Nom du titulaire (nom légal complet, aucune abbréviation): Monsanto Canada Inc.

Adresse: 180 Kent Street, Suite 810

Ville: Ottawa

État: ON

Pays: Canada

Code postal /Zip: K1P 0B6

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

16-JUL-10

5. Lieu de l'incident.

Pays: UNITED STATES

État: ALABAMA

6. Date de la première observation de l'incident.

21-JUN-10

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 71995-29

Nom du produit: Roundup Weed and Grass Killer Concentrate Plus

  • Matière active
    • DIQUAT
      • Garantie/concentration .73 %
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Garantie/concentration 18 %

7. b) Type de formulation.

Autre (préciser)

Concentration

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Autre

2.Type d'animal touché

Dog / Chien

3. Race

Unspecified Mix

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

10

7. Poids (fournir un ordre de grandeur si nécessaire)

85

lbs

8. Voie(s) d'exposition:

Orale

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

  • Système gastro-intestinal
    • Symptôme - Anorexie
  • General
    • Symptôme - Lethargie
  • Système gastro-intestinal
    • Symptôme - Vomit
  • General
    • Symptôme - Adipsie
    • Symptôme - Muqueuse de couleur pâle
  • Système respiratoire
    • Symptôme - Toux
  • General
    • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Contact treat.area/Contact surf. traitée

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

Signalment 10.0 yr neutered male weighing 85.0¿5.0 lb. Was in good health previously. Normal environment: outdoors mostly. Patient Note [Note : Dog is nearly blind x 4-5 years. (by JS on Jun 23, 2010 at 08:12 AM; amended by DM on Jun 23, 2010 at 08:32 AM)] Agent Exposure Roundup Weed and Grass Killer Concentrate Plus (evidence agent id) Possible exposure occurred on Jun 21, 2010 at 12:00 PM CDT (not specific ). Exposure involved unknown amount orally. The exposure was yard use, and occurred at animal owner yard. The use was appropriate. [Note : Owner stated that he applied the Roundup product 4-5 days ago. The dog has been exhibiting signs of vomiting, inappetance, and lethargy for the past 2 days. Owner said he saw grass in the first few vomitus and the vomitus is all liquid now. The owner did say that he is not certain if this is what the dog was exposed and that it could have gotten into something at a neighbor's house. (by JS on Jun 23, 2010 at 08:12 AM)] Because the amount was unknown consistent, the patient was considered to be at high risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : Risk of mild and self-limiting GI upset (vomiting and hypersalivation). The timing and severity of signs here are not consistent with the reported exposure. (by DM on Jun 23, 2010 at 08:32 AM)] Potential Cause Roundup Weed and Grass Killer Concentrate Plus Because the time course was poorly consistent, the amount was unknown consistent, and the findings were somewhat consistent, this substance was considered to have low likelihood of causing the clinical situation. Jun 23, 2010 at 08:12 AM CDT (name), (name)(toxicologist) interacted with Mr. (name) (owner) for reason: obtain help. [Note : Spoke with owner about his dog that might have been exposed to a roundup product. (by JS on Jun 23, 2010 at 08:32 AM)] [Note : Spoke with the owner about this case. He's reluctant to take the dog to a veterinarian due to finances. He mentioned malicious poisoning with EG as a possible concern. He also mentioned that the gums are pale. He's given Pepto Bismol x 2 days. I told him that the Roundup was not the cause of the dog's signs and tried to encourage him to seek veterinary care. (by DM on Jun 23, 2010 at 08:32 AM)] Jun 24, 2010 at 06:32 PM CDT (name), (name)(veterinarian) interacted with Mr. (name) (owner) for reason: update case-in. [Note : Owner is concerned that his neighbor poisoned the dog. Owner states he spoke with a local DVM regarding the dog, but he could not afford to take the dog in for treatment. The dog died today. Owner also states he noted some coughing along with the other signs the dog was exhibiting. Explained to owner that he could have a post-mortem exam performed by his rDVM to try and determine cause of death, but in most cases trying to identify if a pet was poisoned and by whom is extremely difficult if not impossible. Owner has already buried the dog. Owner wanted to discuss possible causes of death. Again reiterated that Roundup exposure would not be expected to cause death. (by CA on Jun 24, 2010 at 07:16 PM)] [Note : Owner calling to report that Spotty died earlier today. He has been having issues with his neighbor who threatened to kill Spotty. Owner was curious about what types of poisons could kill a dog, particularly antifreeze. Transferred to DVM. (by EP on Jun 24, 2010 at 06:32 PM)]


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici