Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4964

2. Registrant Information.

Registrant Reference Number: 120124377

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.

15-OCT-12

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

29-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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 524-308

Product Name: Honcho Plus Herbicide

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 41 %

---

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 / Oiseau

3. Breed

Guinea Fowl

4. Number of animals affected

11

5. Sex

Unknown

6. Age (provide a range if necessary )

0.09

7. Weight (provide a range if necessary )

3

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

• 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

Guinea Fowl group of 11 (Bird) Signalment 5.0 wk Unk weighing 3.0 lb. Was in good health previously. Normal environment: barn. Agent Exposure Honcho Plus Herbicide (suspected agent id) Observed exposure occurred on Aug 29, 2012 at 11:00 AM CDT (suspected ). Exposure involved unknown amount orally. The exposure was accidental, and occurred at animal owner field/pasture. [Note : The owner sprayed an area with Honcho Plus around 8-27-12. Starting on 9-1-12, he has had 11 Guinea die. He wants to know if this is related? (Sep 04, 2012 at 01:26 PM)] Because the amount was poorly 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 : Glyphosate has a wide safety margin. If some is ingested while still wet, might see mild gi upset. Would not expect significant signs, would certainly not expect death. I would recommend having DVM do necropsy and submit histopath, or send recently dead bird to a diagnostic lab (Sep 06, 2012 at 01:14 PM)] Clinical Status Death (11) {General Disorders} Begin: Sep 01, 2012 at 12:00 PM CDT Status: Death Potential Cause Honcho Plus Herbicide Because the time course was not consistent, the amount was poorly consistent, and the findings were not consistent, this substance was considered to have not related likelihood of causing the clinical situation. Patient Care Planned/Recommended Care Call Veterinarian Purpose: Information; Importance: Important Who: Owner ; Willingness: Willing Recommended Call Back With Questions Purpose: Information; Importance: Important Who: Owner ; Willingness: Willing Recommended No Follow Up - See Details Purpose: Information; Importance: Important Who: Owner ; Willingness: Willing Recommended Outcome Unknown , EPA max illness designation: D-A

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here