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: 2007-8039

2. Registrant Information.

Registrant Reference Number: 2007Nov Canada 1

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.

Human

4. Date registrant was first informed of the incident.

22-OCT-07

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

06-AUG-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. 27736      PMRA Submission No.       EPA Registration No.

Product Name: Vision MAX

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

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Crew was spraying broadcast. The weather conditions were hot (25 degrees approx) and little to no wind. Three employees began experiencing eye irritation likely due to sweat mixed with herbicide mist that ran into employee's eyes.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Irritated eye

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Occupational

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

Application

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

Unknown

10. Route(s) of exposure.

Eye

11. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 h

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.)

3 employees began experiencing eye irritation in the early afternoon after broadcast application throughout the day. The sweat and mist entered eyes without eye protection or sweat bands to prevent sweat from entering into eyes. The employees were instructed to use the eye wash and rest until feeling better. At approximately 6pm they were driven to a health facility to be checked by a physician. After waiting 2 additional hours, one employee left prior to seeing a doctor. The other two employees were treated. One of the employees only felt irritation after poked in the eye by an aspen leaf. He left after 3 hours of waiting. He was asked repeatedly if he wanted morphine, he did not feel that morphine was appropriate for his injury.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Information provided by [name] form.