Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4907

2. Registrant Information.

Registrant Reference Number: 31882055

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.

Human

4. Date registrant was first informed of the incident.

15-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: VIRGINIA

6. Date incident was first observed.

29-AUG-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 524-445

Product Name: Roundup Herbicide

• Active Ingredient(s)
  • GLYPHOSATE
    • Guarantee/concentration 41 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

No

9. Application Rate.

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

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Unresponsive

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Poisoning from ingestion of the pesticide

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

10. Route(s) of exposure.

Oral

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Caller states her sister-in -law drank a pint of Roundup - unknown formulation yesterday. The woman was out on pass from a psychiatric center and when she returned she was vomiting. She is currently in a health care facility, unresponsive or sedated and on a ventilator. The caller states the Virginia Poison Center is aware of the case. MRPC contacted the Blue Ridge Poison Center and was unable to get the details regarding the woman's current medical status. On follow up the next day at the Blue Ridge Poison Center, there was no change in the woman's status. Per history, she had been vomiting and then became unresponsive in the ER. Remains intubated and on a ventilator. Unknown if any co-ingestants involved. Unknown if endoscope done. No further information given. Blue Ridge Poison Center to remain the primary center. The MRPC advised if further consult needed by Blue Ridge Poison Center or healthcare facility, to call MRPC. On follow up, the woman was extubated on the next day, was medically stable and had transferred out of the ICU. No other details available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.