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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2545

2. Registrant Information.

Registrant Reference Number: 100038354

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

Address: 180 Kent Street, Suite 810

City: Ottawa

Prov / State: ON

Country: Canada

Postal Code: K1P 0B6

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

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: NEVADA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-40

Product Name: Roundup Concentrate Extended Control Weed And Grass Killer Plus Weed P

  • Active Ingredient(s)
    • DIQUAT
      • Guarantee/concentration .73 %
      • Guarantee/concentration 18 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

About 2 weeks ago, owner had a company come and spray this product on his yard

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


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


  • General
    • Symptom - Lethargy
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


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

Agent Exposure Roundup Concentrate Extended Control Weed And Grass Killer Plus Weed Preventer (observed agent id) Evidence exposure occurred on Mar 16, 2010 at 12:00 PM CDT (observed ). Exposure involved 0.0 Not App (not specific) by unknown route. The exposure was accidental, and occurred at animal owner home. The agent was obtained from Other Retailer. The lot number was unknown. The expiration date was null. [Note : About 2 weeks ago, owner had a company come and spray this product on his yard. About 2 hours after that, dogs were let outside. 2 days later, the male dog began acting sad and didn't want to eat. He died today. The female dog started vomiting 2 days ago, and not wanting to eat. (by (name) on Mar 30, 2010 at 10:42 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 : This product contains glyphosate. We could see mild and self-limiting GI upset (nausea, vomiting) from the surfactants in the product, if it was ingested while it was still wet. We would not expect to see any clinical signs from the active ingredient. (by (name) on Mar 30, 2010 at 11:00 PM)] Potential Cause Roundup Concentrate Extended Control Weed And Grass Killer Plus Weed Preventer 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.

To be determined by Registrant

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


19. Provide supplemental information here

Two Dogs were involved in this incident, however only one dog died. Therefore the one that died was the only one entered into this incident report.