Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3927

2. Registrant Information.

Registrant Reference Number: 120084619

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.

01-AUG-12

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

19-JUN-12

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. 71995-29

Product Name: Roundup Weed and Grass Killer Concentrate Plus

• Active Ingredient(s)
  • DIQUAT, PRESENT AS DIBROMIDE
    • Guarantee/concentration .73 %
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 18 %

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7. b) Type of formulation.

Other (specify)

Concentrate

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

Dog / Chien

3. Breed

Dachshund

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Weight loss

• General
  • Symptom - Dehydration

• Gastrointestinal System
  • Symptom - Loss of appetite

• General
  • Symptom - Death

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

Signalment 12.0 wk intact female weighing 5.0 lb. Was in good health previously. Normal environment: fenced. Agent Exposure Roundup Weed and Grass Killer Concentrate Plus (observed agent id) Observed exposure occurred on Jun 19, 2012 at 05:00 PM CDT (observed ). Exposure involved 0.0 Not App (not specific) orally. The exposure was yard use, and occurred at animal owner home. The use was appropriate. [Note : On Tuesday owner sprayed Roundup and saturated the weeds around the enclosure outside where the pets are kept. Owner noticed vomiting on Wednesday. Vomiting has continued since. Pets seem to be losing weight rapidly and are disinterested in food and appear dehydrated. Owner has tried to give a small meal to the puppies. Both food and water stay down for a maximum of 30 minutes before vomiting occurs. (by name on Jun 22, 2012 at 09:35 AM)] Because the amount was unknown consistent, the patient was considered to be at unknown risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : GI upset may occur. Severe signs would not be expected if this were casual exposure to diluted agent on plants around cage. (by name on Jun 23, 2012 at 10:28 AM)] Clinical Status Vomiting {Digestive} [Note : Foamy white vomitus, no food (by LP on Jun 22, 2012 at 09:35 AM)] Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Anorexia {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Emaciation {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Dehydration {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Mild End: Jun 22, 2012 at 09:40 AM CDT Status: Death Death {General Disorders} Permanent: Jun 22, 2012 at 09:40 AM CDT Status: Death Per owner, right after speaking with us she went to gather the patients up and go to the vet but the bodies were already cold and both patients had passed away. Owner was upset and didn't really want to talk about it. Unsure if qualified for necropsy.

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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

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

American Bulldog

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.17

7. Weight (provide a range if necessary )

7

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Weight loss
  • Symptom - Loss of appetite

• General
  • Symptom - Dehydration
  • Symptom - Death

12. How long did the symptoms last?

Unknown / Inconnu

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

Signalment 8.0 wk intact female weighing 7.0 lb. Was in good health previously. Normal environment: fenced. Agent Exposure Roundup Weed and Grass Killer Concentrate Plus (observed agent id) Observed exposure occurred on Jun 19, 2012 at 05:00 PM CDT (observed ). Exposure involved 0.0 Not App (not specific) orally. The exposure was yard use, and occurred at animal owner home. The use was appropriate. [Note : On Tuesday owner sprayed Roundup and saturated the weeds around the enclosure outside where the pets are kept. Owner noticed vomiting on Wednesday. Vomiting has continued since. Pets seem to be losing weight rapidly and are disinterested in food and appear dehydrated. Owner has tried to give a small meal to the puppies. Both food and water stay down for a maximum of 30 minutes before vomiting occurs. (by name on Jun 23, 2012 at 10:28 AM)] Because the amount was unknown consistent, the patient was considered to be at unknown risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. [Note : GI upset may occur. Severe signs would not be expected if this were casual exposure to diluted agent on plants around cage. (by name on Jun 23, 2012 at 10:28 AM)] Clinical Status Vomiting {Digestive} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Anorexia {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Emaciation {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Moderate End: Jun 22, 2012 at 09:40 AM CDT Status: Death Dehydration {General Disorders} Begin: Jun 21, 2012 at 09:00 AM CDT Status: Mild End: Jun 22, 2012 at 09:40 AM CDT Status: Death Death {General Disorders} Permanent: Jun 22, 2012 at 09:40 AM CDT Status: Death Per owner, right after speaking with us she went to gather the patients up and go to the vet but the bodies were already cold and both patients had passed away. Owner was upset and didn't really want to talk about it. Unsure if qualified for necropsy.

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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