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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0524

2. Registrant Information.

Registrant Reference Number: 90081495

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: NEW YORK

6. Date incident was first observed.

20-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-26

Product Name: Roundup Weed and Grass Killer Concentrate

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 25 %

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

Labrador retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10.5

7. Weight (provide a range if necessary )

90

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

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Loss of appetite
  • Respiratory System
    • Symptom - Dyspnea
  • General
    • Symptom - Cancer
    • Specify - Hemangiosarcoma
    • Symptom - Death
  • Cardiovascular System
    • Symptom - Cardiac arrest

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?

Other / Autre

specify Dog in yard while treatment was applied

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Note : Per owner, the dog was taken to the vet the evening of consultation (7/20). The vet thought he might have been having complications from pancreatitis. They placed him on fluids. The dog was transfered to the 24 hour emergency clinic where they did blood work and IV fluids. The dog began to have trouble breathing and then cardiac arrest, the staff tried CPR. They realized that the lungs were filling with blood. It was then found out the dog had a hemangiosarcoma that had ruptured and this is what caused the death of the animal.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Because the amount was unknown consistent, the patient was considered to be at medium risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. Note : Ingestion of this agent when it is wet can cause hypersalivation and mild and self limiting vomiting. It was found the dog had a hemangiosarcoma that had ruptured and this is what caused the death of the animal.