Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1233

2. Registrant Information.

Registrant Reference Number: 100077305

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.

16-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

13-JUN-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. 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 %

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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: Pub. Area - Outdoor/Zone publique - ext

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

Fish / Poisson

3. Breed

Koi

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Spray drift / Dérive de pulvérisation

17. Provide any additional details about the incident

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

Signalment Age unknown Unknown weighing unknown amount. Normal environment: fresh water. Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (evidence agent id) Possible exposure occurred on Jun 13, 2010 at 09:07 AM CDT (suspected ). Exposure involved unknown amount by other route. The exposure was accidental, and occurred at public yard. [Note : Caller works at a medical office and they sprayed round up on their .The neighbors have a koi pond and 3 of the koi have died. The vet staff does not know what days the fish died. They sprayed the product on Sunday and the pond is 8-10ft from where they sprayed. There is a fence and vegetation in between the properties and the koi pond is up hill from where they sprayed. The caller does not know how many fish are in this pond. (by (name) on Jun 17, 2010 at 08:57 AM; amended by (name) on Jun 17, 2010 at 09:40 AM)] 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 : The surfactant in Roundup can be toxic to fish. Because the pond is uphill to the application and it was not windy the day of the application it is unlikely the spraying is related to the fish deaths. (by (name) on Jun 17, 2010 at 10:25 AM)] Clinical Status Death (3) {General Disorders} [Note : The caller reports she knows that one fish died yesterday, but she does not know when the other fish died. (by (name) on Jun 17, 2010 at 09:40 AM)] Potential Cause 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 poorly consistent, this substance was considered to have doubtful likelihood of causing the clinical situation. Water Details: Have water quality checked Jun 17, 2010 at 09:40 AM CDT Holding, (name) (veterinarian) interacted with Angel (other caller) for reason: information. [Note : Called (name) back. Advised her that with the details of the exposure ( ie 8-10 feet away and uphill) it is unlikely that this would be related to the Roundup. (name) will be talking to the owner of the fish later today. Discussed the possibility that if it was a windy day with a heavy spray some of the product could have drifted to the pond. (by (name) on Jun 17, 2010 at 10:26 AM)] Jun 17, 2010 at 10:25 AM CDT Holding, (name) (veterinarian) interacted with (name) (other caller) for reason: information. [Note : (name) called to report that she talked to the person who applied the product. He reports he used a nozzle spray and the spray is very small. He also reported it was not windy the day of the application. She wanted to know if the spray were the cause of death wouldnt all the fish die. Discussed the case with Dr. (name) and we agreed given the details of the spraying it is highly unlikely the Roundup is related. With pesticide related deaths in a pond, how many die can depend on a wide variety of factors. The time frame of the death on the fish yesterday does not fit well with a reaction to Roundup. (by (name) on Jun 17, 2010 at 10:40 AM)] Jun 17, 2010 at 10:42 AM CDT (name) (toxicologist) interacted with Dr. (name) (other caller) , (name) (call center staff) for reason: obtain help. [Note : MD (name) calling with questions. (by (name) on Jun 17, 2010 at 10:47 AM)] [Note : Caller is a physician. Fish belong to the neighbor. Caller wanted to know if light use of roundup (ready to use) few feet away from the pond could have killed these fish? His neighbor thinks roundup killer the fish. This is about 60 gallon pond. It is highly unlikely that use of diluted roundup around the pond killed the fish. Hav eht eneighbot call back if they have any questions. (by (name) on Jun 17, 2010 at 10:47 AM)]

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To be determined by Registrant

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

Death

19. Provide supplemental information here