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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5414

2. Registrant Information.

Registrant Reference Number: 100120235

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.

15-OCT-10

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

6. Date incident was first observed.

11-SEP-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. 71995-33

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

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 2 %

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

American Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.21

7. Weight (provide a range if necessary )

30

lbs

8. Route(s) of exposure

Unknown

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

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
    • Symptom - Death
    • Symptom - Parvovirus infection

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Unknown

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 10.0 wk immature male weighing 30.0 lb. Normal environment: indoors mostly. Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (observed agent id) Suspected exposure occurred on Sep 11, 2010 at 10:00 AM CDT (possible ). Exposure involved unknown amount by unknown route. The exposure was accidental, and occurred at animal owner yard. The agent was obtained from Grocery Store. The lot number was 10002186-15. The expiration date was null. [Note : Owner's cousin sprayed the yard and let the dog out into the yard almost immediately after without giving time for the product to dry. (by [initial] on Sep 13, 2010 at 06:13 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 : If dogs lick up the still wet product, can see mild upset stomach from the surfactant ingestion. Once dried, not a problem. If no drooling or vomiting within an hour or so, no problems anticipated (by [initial] on Sep 14, 2010 at 08:28 AM)] Potential Cause Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer Because the time course was not consistent, the amount was somewhat consistent, and the findings were not consistent, this substance was considered to have not related likelihood of causing the clinical situation. Patient Care Planned/Recommended Care Take Animal to Veterinarian Purpose: Other; Importance: Important Who: Owner ; Willingness: Willing Implemented Sep 13, 2010 08:00 PM List of Contacts Sep 13, 2010 at 05:51 PM CDT [name] (toxicologist) interacted with [name] (owner) for reason: obtain help. [Note : Dog may have been exposed to product when used yesterday in a family member's yard. She needs to go to her grandmother's home to get the bottle to get information. Will get pet information then as well, dog has been vomiting today (by [initial] on Sep 13, 2010 at 05:55 PM)] Sep 13, 2010 at 06:13 PM [name of business], [name] (assistant) interacted with [name] (owner) for reason: obtain help. [Note : Owner calling back with product information. Per [name], This is not likely to be related to this exposure. There may be mild GI upset with exposure to this product. Owner should have the pet seen by a vet right away. There is a risk that the puppy will become dehydrated. Owner can have the vet call. (by [initial] on Sep 13, 2010 at 06:29 PM)] Sep 16, 2010 at 12:27 PM CDT [name] (technician) interacted with [name] (owner) for reason: monitor case-out. [Note : Called owner to update the case. [name] was in the shower, spoke to a man, didn't get his name. He said [name] passed away yesterday. He was diagnosed with parvo. (by [initial] on Sep 16, 2010 at 12:34 PM)]


To be determined by Registrant

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

Death

19. Provide supplemental information here