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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0621

2. Registrant Information.

Registrant Reference Number: 90091707

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: WEST VIRGINIA

6. Date incident was first observed.

12-AUG-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. 71995-26

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Other / Autre

specify Goat

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

30

lbs

8. Route(s) of exposure

Respiratory

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Anorexia
  • Renal System
    • Symptom - Blood in urine
    • Specify - Hematuria
  • General
    • Symptom - Death

12. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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 Concentrate (possible agent id) Possible exposure occurred on Aug 08, 2009 at 12:00 AM CDT (evidence ). Exposure involved 0.0 Not App (not specific) orally. The exposure was accidental, and occurred at animal owner home. [Note : The owner reports that she sprayed the other side of the fence 6-7 days ago and the goat may have ingested some of the treated plants. She used a Roundup Weed and Grass Killer concentrate and used it at a higher concentration than labeled but cannot specify how she diluted it. (by (name) on Aug 14, 2009 at 02:30 PM)] Because the amount was poorly 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 : Risk of mild and self-limiting GI upset. These signs are not consistent with the exposure. (by (name) on Aug 14, 2009 at 02:30 PM)] Penicillin - Goat Details:Injections for owner to give Performed Aug 11, 2009 12:00 PM Complete Blood Count Details: Performed Aug 11, 2009 12:00 PM Chemistry Profile Details: Performed Aug 11, 2009 12:00 PM Outcome Died , EPA max illness designation: D-A [Note : The owner stated that the goat died approximately one hour following consult with APSS. (by (name) on Aug 17, 2009 at 05:15 PM)]


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