Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3929

2. Registrant Information.

Registrant Reference Number: 120086434

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: VIRGINIA

6. Date incident was first observed.

20-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. 71995-25

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

Chicken

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

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

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Anticip. permanent/Permanence anticipée

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

Chicken Unspecified (Poultry) Signalment 1.5 yr female weighing unknown amount. Normal environment: fenced. Agent Exposure Roundup Weed and Grass Killer Super Concentrate (observed agent id) Possible exposure occurred on Jun 20, 2012 at 12:00 PM CDT (evidence ). Exposure involved 0.0 Not App (not specific) by unknown route. The exposure was accidental, and occurred at animal owner yard. [Note : The owner applied the product to her yard 6/20. About 5-10 min after the application, the owner allowed her chickens into the tx area. That night, the owner noticed one of her chickens was dead. The next day, she found another dead chicken. The rest of the flock was groggy and had a decrease in their egg production, but they all seem to be doing better now. The owner did not notice anything abnormal from the dead birds before they passed away or before the Roundup situation. The owner mentioned that the weather has been hot in her area. (by name on Jun 25, 2012 at 04:23 PM)] Because the amount was unknown consistent, the patient was considered to be at unknown risk of developing clinical signs. If signs develop, there is unknown risk that those signs will be life-threatening. [Note : based on studies in quail and ducks, glyphosate has a fairly good margin of safety regarding toxicity in avian spp. It is difficult to know the exposure details in this case, but if chickens were brought in to the treated area very soon after application, a risk concern could be expected. (by name on Jun 25, 2012 at 05:13 PM)] Clinical Status Death {General Disorders} Permanent: Jun 20, 2012 at 08:00 PM CDT Status: Death

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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