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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4903

2. Registrant Information.

Registrant Reference Number: 100107889

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: NEW JERSEY

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. 71995-33

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

  • Active Ingredient(s)
      • Guarantee/concentration 2 %

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).

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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Loss of appetite
  • General
    • Symptom - Adipsia
    • Specify - Hypodipsia
    • 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

Signalment 5.0 yr intact male weighing 45.0 lb. Was in good health previously. Normal environment: indoors mostly. Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (evidence agent id) Evidence exposure occurred on Aug 13, 2010 at 08:05 PM CDT (not specific ). Exposure involved 0.0 Not App (not specific) by unknown route. The exposure was accidental, and occurred at animal owner yard. The agent was obtained from Other Retailer. The lot number was DNG. The expiration date was null. [Note : Owner used roundup Friday (he does not remember specifically when it was.) The dog began having symptoms Saturday and then the owner took it into the vet Sunday. (by AA on Aug 17, 2010 at 07:58 PM)] Because the amount was unknown 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 : May cause mild, generally self-limiting gi upset if licked or ingested while product is still wet. Once the agent had dried on the lawn, clinical signs would not be expected with exposure to the treated lawn. The duration and severity of the pets clinical signs are more severe than what would be expected with casual exposure to a treated lawn. (by CA on Aug 20, 2010 at 02:36 AM)] Potential Causes Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer Because the time course was poorly consistent, the amount was unknown consistent, and the findings were somewhat consistent, this substance was considered to have low likelihood of causing the clinical situation. Addison Disease Because the time course was unknown consistent and the findings were generally consistent, this condition was considered to have high likelihood of causing the clinical situation. Unplanned Care Take Animal to Veterinarian Details: Performed Aug 15, 2010 12:00 PM , Effectiveness: Unknown , use (Appropriate ) Amoxicillin - Dog Details: Performed Aug 15, 2010 12:00 PM , Effectiveness: Unknown , use (Appropriate ) Necropsy Details: Performed Aug 23, 2010 02:02 PM [Note : Spoke with the owner briefly. He reports that the dog was diagnosed with Addison's disease. He didn't have any questions about the Roundup exposure. I expressed my condolences. (by DM on Aug 23, 2010 at 02:00 PM)]

To be determined by Registrant

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


19. Provide supplemental information here