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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2716

2. Registrant Information.

Registrant Reference Number: 32151544

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: OHIO

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 524-445

Product Name: Roundup Herbicide

  • Active Ingredient(s)
      • Guarantee/concentration 41 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

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?


Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • General
    • Symptom - Other
    • Specify - developed tumors
    • Symptom - Death

4. How long did the symptoms last?

Persisted until death

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Scott's company forwarded an e-mail from a women expressing concerns that she has about a study she read that indicates the development of tumors in rats exposed to Roundup. Her husband and neighbor both died of tumors. She is concerned about her own health. E-mail reads: I saw the study on rats developing tumors 3 years ago we were exposed to the spraying of the roundup for 2 years in a row we developed tumors just like the rats my husbands got so big he died and litterly i feel like i am now the pictures of our bodies is horrifying. the neighbor lady has since died also. what are you doing to stop this from happening to people. I could go on with more that live close to these mass spraying fields.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

MRPC responded to the e-mail suggesting that she have someone from her physician's office call the MPRC in regards to her concerns about Roundup. The woman responded, stating she was just looking for studies in regards to Roundup and 2,4 D within the last couple of years. Symptoms do not correspond with the expected response to the product. MRPC concerned re: possible misinterpretation of symptoms and/or possible misidentification of product or mixed exposure.