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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2524

2. Registrant Information.

Registrant Reference Number: 130032098

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.

17-APR-13

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

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)

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 %

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).

The exposure was accidental, and occurred at animal owner yard. [Note : Owner applied 3 bottles of this product to a 200x200ft area July 30, 2012. Dog was seen eating grass from this area August 1, 2012.

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

70.0

lbs

8. Route(s) of exposure

Oral

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

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Shaking
  • General
    • Symptom - Adipsia
  • Skin
    • Symptom - Rash
  • General
    • Symptom - Death
  • Skin
    • Symptom - Hives
  • Gastrointestinal System
    • Symptom - Loss of appetite
    • Specify - innapetence
  • Nervous and Muscular Systems
    • Symptom - Recumbent
    • Specify - curl up in a ball

12. How long did the symptoms last?

>6 mos / > 6 mois

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

Yes

14. a) Was the animal hospitalized?

Unknown

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

Evidence exposure occurred on Jul 30, 2012 at 12:00 PM CDT (possible ). Exposure involved 0.0 Not App (not specific) orally. The exposure was accidental, and occurred at animal owner yard. [Note : Owner applied 3 bottles of this product to a 200x200ft area July 30, 2012. Dog was seen eating grass from this area August 1, 2012. Symptoms started that day. She would curl up in a ball in the home and shake. Owner also described her having tufts of hair standing up all over her body. Has been vomiting about once daily and having diarrhea on and off since August. Hives resolved after 4-5 days. Mild inappetance and adipsia began in September. Since November, owner has been force feeding canned food. Has seen 3 vets since exposure. She has been on antibiotics, milk thistle, and B12 shots. (Mar 14, 2013 at 11:15 AM)] Because the amount was poorly consistent, the patient was considered to be at very low risk of developing clinical signs. I


To be determined by Registrant

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

Death

19. Provide supplemental information here