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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2963

2. Registrant Information.

Registrant Reference Number: 110043758

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: ARIZONA

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. 71995-33

Product Name: Roundup Weed and Grass Killer Ready To Use Plus

  • Active Ingredient(s)
      • Guarantee/concentration 2 %

7. b) Type of formulation.


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


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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
    • Symptom - Weakness
    • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Chihuahua Dog named Nika (Canine Domestic) Signalment 2.0 yr intact female weighing 4.0 lb. Was in good health previously. Normal environment: indoors mostly. Agent Exposure Roundup Weed and Grass Killer Ready To Use Plus (evidence agent id) Evidence exposure occurred on Apr 11, 2011 at 11:00 PM CDT (evidence ). Exposure involved 0.0 Not App (not specific) orally. The exposure was accidental, and occurred at animal owner yard. [Note : 2 days ago, the pet ate a leaf the product was sprayed on, possibly a dandelion. (by on Apr 13, 2011 at 03:22 PM)] Because the amount was somewhat 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 : If the product was ingested wet, there can be signs of hypersalivation and mild nausea shortly after exposure. Once dried, it is of no risk to mammals. Would not expect a delay in onset. Dandelions are edible plants and not toxic. (by on Apr 14, 2011 at 09:00 AM)] Clinical Status Vomiting {Digestive} Time Observed: Apr 12, 2011 at 11:00 PM CDT Status: Moderate Lethargy {Nervous} Time Observed: Apr 12, 2011 at 05:00 PM CDT Status: Moderate Weakness {Musculoskeletal} Time Observed: Apr 12, 2011 at 05:00 PM CDT Status: Moderate Death {General Disorders} [Note : Owner stated that the dog has already been buried. (We didn't offer necropsy due to this.) (by on Apr 14, 2011 at 10:03 PM)] Permanent: Apr 14, 2011 at 12:00 AM CDT Status: Death Potential Cause Roundup Weed and Grass Killer Ready To Use Plus Because the time course was poorly consistent, the amount was somewhat consistent, and the findings were poorly consistent, this substance was considered to have not related likelihood of causing the clinical situation. [Note : I do not believe that the Roundup is the cause of this dog's death either. (Dr had originally assessed this as not related.) (by on Apr 14, 2011 at 10:03 PM)] Patient Care Planned/Recommended Care Take Animal to Veterinarian Purpose: Other; Importance: Important Who: Owner ; Willingness: Willing Recommended Have Veterinarian Call for Information Purpose: Information; Importance: Potential Who: Owner ; Willingness: Willing Recommended No Follow Up - No Add'n Info Expected Purpose: Information Who: Not asked ; Willingness: Not asked Recommended Outcome Died , EPA max illness designation: D-A List of Contacts Apr 13, 2011 at 03:22 PM CDT (technician) interacted with (owner) for reason: obtain help. [Note : Per Dr. , would not expect this to be related to the exposure, onset would have been much sooner, and typically only mild self limiting GI upset. Nika needs to go into the vet. Recommend trying to figure out if pet has been exposed to anythign else recently. Can have DVM call with querstions. (by MM on Apr 13, 2011 at 03:36 PM)] Apr 14, 2011 at 08:11 PM CDT (technician) interacted with (owner) for reason: update case-in. [Note : Owner calling back to update case. When we spoke with owner yesterday, she was calling from work. She came home after work to find her pet had passed away. She buried her in the yard. She never took it into the vet. Tried asking her about other exposures, but owner could not think of anything else. She insists the roundup was the cause of death. Was going to transfer to DVM, but caller disconnected. Due to her fragile state, Dr. did not feel it was appropriate to call owner back. (by on Apr 14, 2011 at 08:17 PM)]

To be determined by Registrant

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


19. Provide supplemental information here