Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4215

2. Registrant Information.

Registrant Reference Number: 120107911

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.

11-SEP-12

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

01-AUG-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. 71995-33

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

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

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Ataxia

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

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 3.0 mo immature male weighing unknown amount. Normal environment: barn. Agent Exposure Roundup Weed And Grass Killer Ready To Use Plus Pump N Go Sprayer (observed agent id) Evidence exposure occurred on Aug 01, 2012 at 04:00 PM CDT4 hr (not specific ). Exposure involved 0.0 Not App (not specific) by unknown route. The exposure was accidental, and occurred at animal owner yard. [Note : Owner's husband sprayed Roundup per label on Wednesday 8/1. Spooky may have ran through the area the next evening and began vomiting Thursday evening. He also developed lethargy and ataxia this morning and continued vomiting today. (on Aug 03, 2012 at 11:52 AM)] Clinical Status Vomiting {Digestive} Begin: Aug 02, 2012 at 08:00 PM CDT Status: Mild End: Aug 03, 2012 at 09:45 PM CDT Status: Death Lethargy {Nervous} Begin: Aug 03, 2012 at 09:00 AM CDT Status: Mild End: Aug 03, 2012 at 09:45 PM CDT Status: Death Ataxia {Nervous} Begin: Aug 03, 2012 at 09:00 AM CDT Status: Mild End: Aug 03, 2012 at 09:45 PM CDT Status: Death Death {General Disorders} Permanent: Aug 03, 2012 at 09:45 PM CDT Status: Death I called the owner to update the case. The owner states that the pet died on 8/3 while at the clinic. A necropsy was conducted on 8/4. The owner states that the results stated that the pet had feline parvo. Called clinic to obtain copy of the necropsy report. DVM did gross at clinic. Owner refused histopath. GI tract was mildly dilated with yellow mucosal fluid Color change in stomach 3" area in jejunum that potentially had ulcerated Thymus atrophied possibly (hard to tell given the age of the animal) Mesinteric Lymph nodes enlarged. Toxicity unlikely according to her evaluation. Hypoglycemic upon admission (couldn't even be read by machine)

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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