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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5680

2. Registrant Information.

Registrant Reference Number: 100140842

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.

12-NOV-10

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

26-OCT-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. 524-445

Product Name: Roundup Original Herbicide

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 41 %

7. b) Type of formulation.

Other (specify)

Concentrate

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

Rottweiler

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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 - Rectal hemorrhage
    • Symptom - Anorexia
  • General
    • Symptom - Adipsia
    • 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 1.0 yr intact male weighing 0.0 lb. Was in good health previously. Normal environment: indoors mostly. Agent Exposure Roundup Original Herbicide (unknown agent id) Unknown exposure occurred on Oct 26, 2010 at 03:42 PM CDT¿12 hr (not specific ). Exposure involved unknown amount orally. The exposure was accidental, and occurred at animal owner yard. The agent was obtained from Other Retailer. The lot number was did not have. The expiration date was null. [Note : Owner sprayed a Roundup product (formulation unknown) on or about 10/26; her Rottweiler developed anorexia, adipsia and rectal hemorrhage two days later. Dog was treated at vet on the 28th, and dog died this morning. A second dog in the household just vomited about 30 minutes prior to consultation, and a third dog remains asymptomatic. (by AM on Oct 30, 2010 at 03:39 PM)] Because the amount was unknown consistent, the patient was considered to be at medium risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : Ingestion of the wet product may cause a taste reaction and hypersalivation and/or vomiting are possible. Once the product is dry, it is virtually non-toxic. Dying plants may become more palatable, and they themselves could pose a risk for mechanical irritation and possibly their own toxic nature. The Rottweiler's signs are not consistent with exposure to this agent, and the Lab mix vomiting several days after potential exposure is not related. (by AM on Oct 30, 2010 at 03:39 PM)] Potential Cause Roundup Original Herbicide Because the time course was poorly consistent, the amount was unknown 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

Death

19. Provide supplemental information here

There were 3 dogs involved in this incident, however the outcomes were unknown for 2 of the dogs. Therefor only 1 dog was entered into this report.