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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2731

2. Registrant Information.

Registrant Reference Number: 100053674

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.

14-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

29-APR-10

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. 524-529

Product Name: Roundup Pro Concentrate

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 50.2 %

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: 3:1 dilution

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

Chihuahua mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

7.5

lbs

8. Route(s) of exposure

Oral

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • Eye
    • Symptom - Discharge eye
    • Specify - Mucopurulent Ocular Discharge
  • General
    • Symptom - Parvovirus infection
    • 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

Signalment 5.0 mo immature male weighing 7.5 lb. Was in good health previously. Normal environment: indoors mostly. Agent Exposure Roundup Pro Concentrate (EPA 524-529) (not specific agent id) Observed exposure occurred on Apr 29, 2010 at 12:00 PM CDT (not specific ). Exposure involved 0.0 Not App (not specific) orally. The exposure was accidental, and occurred at animal owner yard. The agent was obtained from Friend. The lot number was n/a. The expiration date was null. [Note : The owner had diluted the product 3/1, per instructions, and had used it in the yard a few days ago. Yesterday Oso drank out of a bowl under some sticks that had standing water in it, that had been in the sprayed area. Last night he became lethargic, is vomiting clear fluid and now bile, has yellow-green diarrhea, and a yellow-green mucoid discharge from his eyes. (by (name) on Apr 30, 2010 at 12:46 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 : When diluted and ingested wet, there could be mild, self-limiting GI upset. Would not expect this severity of signs. Suspect other etiologies, such as infectious/bacterial agents from the standing water, or other etiologies. (by (name) on Apr 30, 2010 at 12:46 PM)] Potential Causes Roundup Pro Concentrate (EPA 524-529) Because the time course was poorly consistent, the amount was poorly consistent, and the findings were poorly consistent, this substance was considered to have not related likelihood of causing the clinical situation. Parvovirus Because the time course was generally consistent and the findings were generally consistent, this condition was considered to have high likelihood of causing the clinical situation. [Note : Per owner update, pet was diagnosed with parvovirus. Treated in hospital symptomatically and supportively. Pet died early morning 4/4/10. (by (name) on May 06, 2010 at 01:29 PM)]


To be determined by Registrant

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

Death

19. Provide supplemental information here