Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4482

2. Registrant Information.

Registrant Reference Number: 110101245

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.

14-SEP-11

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

30-JUL-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)

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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: 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

Other / Autre

specify goat

3. Breed

Nubian Goat

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

50

lbs

8. Route(s) of exposure

Unknown

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

System

• General
  • Symptom - Weakness
  • Symptom - Vocalizing
  • Symptom - Death
  • Symptom - Hesitancy to move
  • Specify - did not want to get up

12. How long did the symptoms last?

Persisted until death

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Nubian Goat named Scotty (Caprine) Signalment 6.0 mo neutered male weighing 50.0 lb. Was in good health previously. Normal environment: barn. Patient Note [Note : Pet is healthy and no medications. Goats are wormed regularly. (by [initial] on Aug 06, 2011 at 03:12 PM)] Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (observed agent id) Observed exposure occurred on Jul 30, 2011 at 12:00 PM CDT 4 hr (observed ). Exposure involved 0.0 Not App (not specific) orally. The exposure was accidental, and occurred at animal owner home. The agent was obtained from Other Retailer. The lot number was n/a. The expiration date was null. [Note : Pet owner calling because her goat could have possibly ingested some Roundup. The pet owner applied the product 7 days ago. Pet owner noticed this morning that the pet became week and did not want to get up. Pet owner stated that the pet was also vocalizing. Pet owner gave the pet Penicillin, Fenbendazole, and Pepto. Pet owner believes the pet is getting progressively worse. (by [initial] on Aug 06, 2011 at 03:12 PM)] Because the amount was somewhat 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 : With this exposure, we can see GI upset. As the plants that have been sprayed die, they do release sugars and become more palatable, so it would be possible that the goat has ingested a noxious plant that normally he would leave alone. (by [initial] on Aug 07, 2011 at 02:54 PM)] Clinical Status Weakness (Musculoskeletal) Begin: Aug 06, 2011 at 07:00 AM CDT Status: Moderate End: Aug 06, 2011 at 04:00 PM CDT Status: Death Vocalization (General Disorders) Begin: Aug 06, 2011 at 07:00 AM CDT Status: Mild End: Aug 06, 2011 at 04:00 PM CDT Status: Death Death (General Disorders) End: Aug 06, 2011 at 04:00 PM CDT Status: Death Potential Cause Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer Because the time course was not consistent, the amount was somewhat 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 Take Animal to Veterinarian Purpose: Other Importance: Important Who: Owner Willingness: Willing Refused Have Veterinarian Call for Information Purpose: Information Importance: Important Who: Owner Willingness: Willing Recommended Unplanned Care Penicillin - Goat Details:2.5 to 3 ml Performed Aug 06, 2011 08:30 AM , Effectiveness: Unknown , use (Unknown ) Bismuth Subsalicylate Goat Details:2 tbsp Performed Aug 06, 2011 12:30 PM , Effectiveness: Unknown , use (Unknown ) Fenbendazole goat Details: Performed Aug 06, 2011 10:30 AM , Effectiveness: Unknown , use (Unknown ) Outcome Died , EPA max illness designation: DA

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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