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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0523

2. Registrant Information.

Registrant Reference Number: 90076344

Registrant Name (Full Legal Name no abbreviations): Monsanto Canada Inc.

Address: 350 Albert St., Suite 315

City: Ottawa

Prov / State: ON

Country: CANADA

Postal Code: K1R 1A4

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

22-JAN-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WISCONSIN

6. Date incident was first observed.

07-JUL-09

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. 71995-33

Product Name: Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 2 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-33

Product Name: Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer

  • Active Ingredient(s)

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

Weimaraner

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

110

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Bloody stool
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • General
    • Symptom - Lethargy
  • Respiratory System
    • Symptom - Difficulty Breathing
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Unknown

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

Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (observed agent id) Possible exposure occurred on Jul 06, 2009 at 12:00 PM CDT (possible ). Exposure involved 0.0 Not App (not specific) by unknown route. The exposure was accidental, and occurred at animal owner yard. [Note : The yard was sprayed with Round-up 07/06/09. The dog has had access to the yard since then. Yesterday the dog became lethargic and started vomiting. Today the dog has labored breathing and has bloody stool. (by (name) on Jul 08, 2009 at 06:35 PM)] Because the amount was somewhat consistent, the patient was considered to be at low risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : Would not expect signs of this severity or duration. Would not expect late onset of signs. Worst I would have expected would be mild GI upset on Monday (by (name) on Jul 08, 2009 at 06:48 PM)] [Note : Spoke with rDVM about case. Discussed typical signs from Roundup. The timing doesn't fit the exposure. Once product is dry, it is non toxic. However, if plants had started to wilt, they are sometimes more palatable, and dog could have ingested plants, thus causing gi signs. However, the labored breathing and ataxia are not expected signs. Could dog have been exposure to other toxins...any chance of mushrooms being out in yard? Owners could not rule out the presence of mushroom exposure. Dog was known to pick things up in her mouth.


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 poorly consistent, the amount was somewhat consistent, and the findings were poorly consistent, this substance was considered to have doubtful likelihood of causing the clinical situation.