Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0343

2. Registrant Information.

Registrant Reference Number: 110157809

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-JAN-12

5. Location of incident.

Country: UNITED STATES

Prov / State: UNKNOWN

6. Date incident was first observed.

13-NOV-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. 71995-25

Product Name: Roundup Weed and Grass Killer Super Concentrate

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

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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

Bird - Poultry / Oiseau - Volaille

3. Breed

duck

4. Number of animals affected

162

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

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?

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

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

Duck Unspecified group of 162 (Bird) Signalment 0.0 DND Unknown weighing 0.0 DND. Normal environment: roaming. Agent Exposure Roundup Weed and Grass Killer Super Concentrate (observed agent id) Possible exposure occurred on Nov 13, 2011 at 01:48 PM CST 12 hr (possible ). Exposure involved unknown amount dermally and orally. The exposure was yard use. (Note : Owner used agent on grass about a month ago, ducks were seen eating grass. About 162 of 250 ducks have died, deaths started about 24 hours after spraying. DVM does not know about clinical signs. (by (name) on Dec 13, 2011 at 01:31 PM)) Because the amount was generally 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 : Exposure to agent can cause vomiting and irritation to mucous membranes. (by (name) on Dec 13, 2011 at 01:31 PM)) Clinical Status Death (162) {General Disorders} Begin: Nov 14, 2011 at 01:46 PM CST Status: Death Potential Cause Roundup Weed and Grass Killer Super Concentrate Because the time course was poorly consistent, the amount was generally 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 Who: Not asked ; Willingness: Not asked Refused, Reason: Unknown Obtain Additional Information Purpose: Information; Importance: Important Who: Regular Veterinarian ; Willingness: Willing Recommended Details: Need more information about exposure timing and clinical signs of ducks Outcome Died , EPA max illness designation: D-A

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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