Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8569

2. Registrant Information.

Registrant Reference Number: 2007Aug13 Canada

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.

10-AUG-07

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

24-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-36

Product Name: Roundup RTU Poison Ivy + Tough Brush Killer Plus EPA No.: 71995-36

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 1 %
  • TRICLOPYR TRIETHYLAMINE SALT
    • Guarantee/concentration .1 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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 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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Seizure

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)

Contact with treated area

Amount of time between application and contact 1

Day(s) / Jour(s)

What was the activity? Checking the area

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

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 paramedic contacted the (name) from (city) as he was enroute to (name) with a male who sprayed Roundup Ready to Use Poison Ivy and Tough Brush Killer Plus on his weeds yesterday. The wind may have been blowing; the man can not recall a direct mist to his skin. He was outside today checking the area then came inside. Once inside he had a grand mal seizure. He has had no direct exposure of the product to his skin. He denies any ingestion of product or exposure to other products. The PCC discussed the product toxicity and advised the symptoms are unrelated. EMS declined any follow up by the PCC.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The Poison Control Center discussed the product toxicity and advised the symptoms are unrelated.