Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-4712
2. Registrant Information.
Registrant Reference Number: 2007Jul14 Canada 70057174
Registrant Name (Full Legal Name no abbreviations): Monsanto
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.
Domestic Animal
4. Date registrant was first informed of the incident.
13-JUL-07
5. Location of incident.
Country: UNITED STATES
Prov / State: KENTUCKY
6. Date incident was first observed.
03-JUN-07
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.
Product Name: Roundup Weed and Grass Killer Ready to Use Plus EPA Reg. No. 71995-33
- Active Ingredient(s)
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
- Guarantee/concentration 2 %
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).
Site: Res. - Out Home / Rés - à l'ext.maison
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Beagle
4. Number of animals affected
3
5. Sex
Male
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
12
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
12. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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
Not recovered / Non rétabli
16. How was the animal exposed?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
APSS: Some of the Roundup spilled on a large bag of dog food. Owner took out the wet food and set it aside. His neighbor feeds the dogs occasionally and owner believes dogs were accidentally given food that contained the Roundup. If a dog got into spilled product and licked up enough, could see transient GI upset with mild vomiting due to the surfactants. Would expect such signs within 1-2 hours. Not consistent with these signs.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Because the time course was not consistent, the amount was unknown consistent, and the findings were not consistent, this substance was considered to have not related likelihood of causing the clinical situation. APSS Case: 70057174