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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-1172
2. Registrant Information.
Registrant Reference Number: 2008Mar APSS 80017164
Registrant Name (Full Legal Name no abbreviations): Monsanto
Address: 800 N. 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.
14-MAR-085. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
16-FEB-08Product 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 Concentrate Plus
- Active Ingredient(s)
- DIQUAT
- Guarantee/concentration .73 %
- GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
- Guarantee/concentration 18 %
- DIQUAT
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 III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
Doberman Pinscher
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
6
7. Weight (provide a range if necessary )
80
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Death
12. How long did the symptoms last?
Unknown / Inconnu
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
Died
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Exposure involved unknown amount dermally and orally. The exposure was accidental, and occurred at animal owner yard. Animal was outdoors and had access to freshly applied product. Next afternoon found animal dead. A few minutes before that animal had been running in the yard and seemed fine. No anthelmentic used by owner. Nothing else owner knows of that animal could have been exposed to. Dobermans are prone to dilated cardiomyophathy. The owner noticed no abdominal distention before or at death. No necropsy performed.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
APSS Case:#. Because the time course was not consistent, the amount was poorly consistent, and the findings were not consistent, this substance was considered to have not related likelihood of causing the clinical situation.
