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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2720

2. Registrant Information.

Registrant Reference Number: 110056757

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.


5. Location of incident.


Prov / State: FLORIDA

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-17

Product Name: Roundup Concentrate Weed And Grass Killer 1

  • Active Ingredient(s)
      • Guarantee/concentration 18 %

7. b) Type of formulation.

Other (specify)


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'

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?


Subform III: Domestic Animal Incident Report

1. Source of Report


2. Type of animal affected

Dog / Chien

3. Breed

Shih Tzu

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms


  • General
    • Symptom - Pale mucous membrane colour
  • Nervous and Muscular Systems
    • Symptom - Rigidity
    • Specify - Jaw Clamping
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident


16. How was the animal exposed?

Other / Autre

specify unknown

17. Provide any additional details about the incident

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

Shih Tzu Dog Mix named Doodles (Canine Domestic) Signalment 1.0 yr neutered male weighing 8.0 lb. Was in good health previously. Normal environment: outdoors mostly. Agent Exposure Roundup Concentrate Weed And Grass Killer 1 (possible agent id) Possible exposure occurred on Apr 19, 2011 at 07:27 PM CDT (possible ). Exposure involved unknown amount by unknown route. The exposure was yard use, and occurred at animal owner yard. [Note : The owner's neighbor applied this product 3 weeks ago. (by (name) on May 10, 2011 at 07:09 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 : When exposure to the wet product some animals may develop nausea, vomiting, (GI upset). Generally signs are mild and self-limiting. (by (name) on May 10, 2011 at 07:09 PM)] Clinical Status Pale Mucous Membrane Color {Cardiovascular} Time Observed: May 10, 2011 at 12:00 PM CDT¿4 hr Status: Severe Jaw Clamping {Musculoskeletal} Time Observed: May 10, 2011 at 12:00 PM CDT¿4 hr Status: Severe Sudden Death {General Disorders} Time Observed: May 10, 2011 at 12:15 PM CDT¿4 hr Status: Death Potential Cause Roundup Concentrate Weed And Grass Killer 1 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. Patient Care Planned/Recommended Care Necropsy Purpose: Diagnostic; Importance: Potential Who: Owner ; Willingness: Willing Recommended Call Back With Questions Purpose: Information; Importance: Potential Who: Owner ; Willingness: Willing Recommended Obtain Additional Information Purpose: Information; Importance: Potential Who: Owner ; Willingness: Willing Recommended Details: Call back if any other potential exposure information becomes available. Outcome Died , EPA max illness designation: D-A List of Contacts May 10, 2011 at 06:54 PM CDT (name) (technician) interacted with (name) (call center staff) , Ms. (name) (owner) for reason: transfer call. [Note : Call center staff transferring pet owner. (by (name)on May 10, 2011 at 07:03 PM)] [Note : Speaking with pet owner. Since Thanksgiving, she has lost 3 pets with very similar symptoms. Her neighbor will use a roundup concentrate product and spray it near her yard. The last time it was sprayed was about 3 weeks ago. Each dog was found with white MM color, clenched jaw, and extreme lethargy, and then they pass away within minutes. Caller cannot think of anything else the dogs have access to in her yard or the neighbor's yard that would be causing this. Explained that roundup can cause mild GI upset when it's wet. This would not be a product that would cause death. (by name on May 10, 2011 at 07:03 PM)] May 10, 2011 at 07:09 PM CDT (name) (veterinarian) interacted with (name)(owner) for reason: update case-in. [Note : Called the owner back (disconnected). The owner stated that she didn't think that the signs were related but wanted to call and see. Briefly discussed other possible exposures with the owner (Metaldehyde, zinc phosphide, snake bites, toads). Recommend the owner walk around the yard to evaluate for other potential exposures. Call back if any information becomes available. The owner states that she has buried Doodles, but recommended the owner consider a necropsy if this should happen again (this is the owner's third loss). (by (name) on May 10, 2011 at 07:33 PM)]

To be determined by Registrant

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


19. Provide supplemental information here