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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3129

2. Registrant Information.

Registrant Reference Number: 110072454

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-JUL-11

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

04-JUN-11

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. 71995-33

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 %

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: 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

Cat / Chat

3. Breed

Siamese

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

14

7. Weight (provide a range if necessary )

12.5

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Diarrhea
  • General
    • Symptom - Adipsia
  • Blood
    • Symptom - Hyperbilirubinemia

12. How long did the symptoms last?

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

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

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

Siamese Cat named [name] (Feline Domestic) Signalment 14.0 yr neutered male weighing 12.5 lb. Was in good health previously. Normal environment: outdoors mostly. Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (suspected agent id) Suspected exposure occurred on Jun 04, 2011 at 11:00 AM CDT (suspected ). Exposure involved unknown amount dermally and orally. The exposure was accidental, and occurred at animal owner yard. The agent was obtained from Grocery Store. The lot number was NA. The expiration date was null. [Note : The owner applied what she thinks is this product (but could have been a generic weed killer) around 6-4-11. The cat was in the yard during application. On 6-7-11, she found the cat lethargic (not wanting to walk), anorexic, adipsic, and having diarrhea. The owner took the cat into the DVM, where he remains. The DVM isn't sure what is wrong with the cat, FIV/FIP negative. He does have an elevated Bilirubin. (by EL on Jun 11, 2011 at 10:28 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 : These signs and time of the onset are not consistent. Mild digestive upset within hours is possible with exposure to wet product. (by IM on Jun 12, 2011 at 12:16 PM)] Clinical Status Lethargy {Nervous} Time Observed: Jun 07, 2011 at 07:00 AM CDT Status: Severe End: Jun 14, 2011 at 12:00 PM CDT Status: Death Anorexia {General Disorders} Time Observed: Jun 07, 2011 at 07:00 AM CDT Status: Mild End: Jun 14, 2011 at 12:00 PM CDT Status: Death Diarrhea {Digestive} Time Observed: Jun 07, 2011 at 07:00 AM CDT Status: Mild End: Jun 14, 2011 at 12:00 PM CDT Status: Death Adipsia {Urinary} Time Observed: Jun 07, 2011 at 07:00 AM CDT Status: Mild End: Jun 14, 2011 at 12:00 PM CDT Status: Death Hyperbilirubinemia {Metabolic Disorders} Time Observed: Jun 07, 2011 at 07:30 AM CDT Status: Mild End: Jun 14, 2011 at 12:00 PM CDT Status: Death Death {General Disorders} Permanent: Jun 14, 2011 at 12:00 PM CDT Status: Death 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. Patient Care Planned/Recommended Care Have Veterinarian Call for Information Purpose: Information; Importance: Important Who: Owner ; Willingness: Willing Recommended Unplanned Care Take Animal to Veterinarian Details: Performed Jun 07, 2011 07:30 AM , Effectiveness: Somewhat , use (Appropriate ) Feline Immunodeficiency Virus Test Details:Negative Performed Jun 07, 2011 07:30 AM , Effectiveness: Somewhat , use (Appropriate ) Feline Infectious Peritonitis Test Details:Negative Performed Jun 07, 2011 07:30 AM , Effectiveness: Somewhat , use (Appropriate ) Chemistry Profile Details: Performed Jun 07, 2011 07:30 AM , Effectiveness: Somewhat , use (Appropriate ) Complete Blood Count Details: Performed Jun 07, 2011 07:30 AM , Effectiveness: Somewhat , use (Appropriate ) Outcome Died , EPA max illness designation: D-A [Note : Pet has been at the RDVM hospitalized for the past week. The pet died today while at the RDVM. RDVM did several tests and one came back questionable for toxoplasmosis. Spoke to Dr. [name] about the case. Since the pet's exposure was several days previous to the signs developing, she doubts that the signs are due to this exposure. She said that Monsanto offers necropies only in rare cases. Dr. [name] feels that this is not an exception to offer a necropsy. (by [intiails] on Jun 14, 2011 at 05:22 PM)]


To be determined by Registrant

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

Death

19. Provide supplemental information here

List of Contacts Jun 11, 2011 at 10:28 AM CDT [name] (technician) interacted with [name] (owner) for reason: obtain help. [Note : Per Dr [name] signs are not related. Have the DVM call us to discuss. Gave the case and follow up numbers. (by [initials] on Jun 11, 2011 at 10:28 AM)] Jun 14, 2011 at 05:19 PM CDT [name] (assistant) interacted with [name] (owner) for reason: monitor case-out. [Note : Called owner to update case. Left message detailing call back and case numbers. (by [initials] on Jun 14, 2011 at 05:21 PM)] Jun 14, 2011 at 05:22 PM CDT [name] (assistant) interacted with [name] (owner) for reason: update case-in.