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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2349

2. Registrant Information.

Registrant Reference Number: 110045914

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.

13-MAY-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

Unknown

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. 71995-25

Product Name: Roundup Weed and Grass Killer Super Concentrate

  • Active Ingredient(s)
    • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
      • Guarantee/concentration 50 %

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

unknown

4. Number of animals affected

1

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?

Persisted until death

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

Canine Domestic Unspecified named Unk (Canine Domestic) Signalment Age unknown weighing unknown amount. Agent Exposure Roundup Weed and Grass Killer Super Concentrate (evidence agent id) Unknown exposure occurred on Unknown Time (unknown ). Exposure involved unknown amount by unknown route. [Note : The caller was spraying the product in her yard, and her neighbor came over and accused the caller that her dog died because he was exposed to the product more than 6 mo ago. The dog's owner was saying before he saw the caller spraying the agent that the dog died probably from EG exposure. No necropsy was performed. (by on Apr 18, 2011 at 01:11 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 : Casual exposures to roundup are not expected to cause much beyond gi upset. (by name on Apr 19, 2011 at 08:25 AM)] Clinical Status Death {General Disorders} Status: Death Potential Cause Roundup Weed and Grass Killer Super Concentrate Because the time course was unknown consistent, the amount was unknown consistent, and the findings were poorly consistent, this substance was considered to have not related likelihood of causing the clinical situation. Patient Care Planned/Recommended Care Provided Information Purpose: Information Who: Not asked ; Willingness: Not asked Recommended No Follow Up - See Details Purpose: Information Who: Not asked ; Willingness: Not asked Recommended Outcome Died , EPA max illness designation: Apr 18, 2011 at 01:11 PM CDT (assistant) interacted with (apss contact) for reason: obtain help. [Note : Per would not expect anything more than mild GI signs with exposure to the agent diluted per label. (by (name) on Apr 18, 2011 at 01:11 PM)] Apr 20, 2011 at 08:21 PM CDT (veterinarian) interacted with (owner) for reason: update case-in. [Note : Owner called back in to discuss (name). She did not wish to discuss the dog that had passed away. (by on Apr 20, 2011 at 08:21 PM)] Apr 23, 2011 at 05:31 PM CDT (assistant) interacted with (owner) for reason: monitor case-out. [Note : Called and spoke with owner to obtain update (by on Apr 23, 2011 at 05:41 PM)]


To be determined by Registrant

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

Death

19. Provide supplemental information here

There were 2 dogs referenced in this case, however only 1 died. Therefore only the 1 dog was entered into this report. Also, this incident was also sent to us from another provider. The information provided in that report was: " the neighbor is claiming that the dog ate where they sprayed this and thats what killed the dog". The incident info, the date, caller name and phone # were the same in both reports. We therefore only submitted one incident report for this case.