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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0915

2. Registrant Information.

Registrant Reference Number: 100154563

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.

07-JAN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

30-NOV-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. 71995-29

Product Name: Roundup Weed and Grass Killer Concentrate Plus

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 18 %

7. b) Type of formulation.

Other (specify)

concentrate

Application Information

8. Product was applied?

No

9. Application Rate.

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

Female

6. Age (provide a range if necessary )

0.46

7. Weight (provide a range if necessary )

24

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

American Pit Bull Terrier named Peaches (Canine Domestic) Signalment 5.5 mo intact female weighing 24.0 lb. Normal environment: outdoors mostly. Patient Note [Note : Baytril Electrolyte solution Pet was evaluated by DVM. Said to possibly be positive for Parvovirus (by MH on Dec 01, 2010 at 12:41 PM)] Agent Exposure Roundup Weed and Grass Killer Concentrate Plus (evidence agent id) Evidence exposure occurred on Nov 30, 2010 at 03:00 PM CST¿5 hr (suspected ). Exposure involved unknown amount orally. The exposure was accidental, and occurred at animal owner home. [Note : Owner found bottle tipped over with some contents missing. Bottle was not full but contained unknown amount. The pet developed symptoms and was brought to DVM for evaluation where the pet was suspected to be positive for parvovirus. (by MH on Dec 01, 2010 at 12:41 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 : Mild self limiting GI upset can occur if this agent is ingested. (by CD on Dec 06, 2010 at 12:45 PM)] Clinical Status Vomiting {Digestive} Time Observed: Nov 30, 2010 at 08:00 PM CST Status: Mild Change: Dec 01, 2010 at 01:00 PM CST Status: Severe Status: Not asked End: Dec 01, 2010 at 01:30 PM CST Status: Death Death {General Disorders} [Note : Per owner update, pet died shortly after an IV catheter was placed. RegDVM stated pet had parvo. (by MM on Dec 06, 2010 at 12:18 PM)] Permanent: Dec 01, 2010 at 01:30 PM CST Status: Death Potential Causes Roundup Weed and Grass Killer Concentrate Plus Because the time course was somewhat 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. Parvovirus Because the time course was unknown consistent and the findings were generally consistent, this condition was considered to have medium likelihood of causing the clinical situation. Patient Care Unplanned Care Take Animal to Veterinarian Details: Performed Dec 01, 2010 08:00 AM Oral Electrolyte Solution Details: Performed Dec 01, 2010 08:00 AM Enrofloxacin - Dog Details: Performed Dec 01, 2010 08:00 AM Place IV Catheter Details: Performed Dec 01, 2010 01:00 PM Outcome Died , EPA max illness designation: D-A


To be determined by Registrant

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

Death

19. Provide supplemental information here