Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5684

2. Registrant Information.

Registrant Reference Number: 32182974

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.

Human

4. Date registrant was first informed of the incident.

10-OCT-13

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

24-SEP-13

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. 524-536-10404

Product Name: Prosecutor Pro Non-Selective Herbicide from Lesco

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

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: unknown product

• Active Ingredient(s)
  • PARAQUAT

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Burning throat
  • Symptom - Irritated throat
  • Specify - red throat
  • Symptom - Difficulty swallowing

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Sore throat
  • Specify - throat pain
  • Symptom - Vomiting

• Respiratory System
  • Symptom - Coughing up blood
  • Specify - bloody sputum

• Gastrointestinal System
  • Symptom - Other
  • Specify - white spots in back of throat

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Yes

6. b) For how long?

3

Day(s) / Jour(s)

7. Exposure scenario

Unknown

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

Poisoning from ingestion of the pesticide

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

Unknown

10. Route(s) of exposure.

Oral

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.)

Caller states, yesterday at work, he drank from a bottle that looked just like a soda bottle, but his co-worker had poured Prosecutor herbicide concentrate, along with another unknown herbicide, into the bottle full strength. He had it in his mouth and spit it right out, stating, he did not swallow any. Caller does not have the labels or EPA numbers. He complains of nonstop pain in his throat but states it is 10% better than yesterday. His spouse states his throat is beet red. The caller states swallowing is uncomfortable but he has been able to eat and drink without difficulty. The caller chose not to go to the ED at the time of exposure or since then. MRPC discussed the product toxicity. Advised to continue soothing and soft foods and referral to the ED if the pain increases or persists. MRPC is unable to determine the effects from the other unknown herbicide. The caller declined follow up call stating he would call back to the MRPC if any questions. About 7 hours later, the ED called about this man who states that earlier this evening at work, he took a swig of what he thought was water and then found out it was a mix of paraquat and Prosecutor concentrates. Unknown concentrations of each. No container available to confirm the ingredients. He complained of throat burning initially followed by " horrible throat pain" and says he can barely swallow. He has had something to drink and eat since it happened. MRPC discussed the product toxicity and potential paraquat toxicity. Advised symptomatic, supportive care, baseline lab work, GI consult for corrosive injury concern and attempt to determine the product formulations. The man was admitted to a medical care floor. On follow up, 8 hours after the last call, the man was doing well with no GI symptoms. Throat pain was continuing. Esophagoscopy was planned for later in the day. BP wnl, baseline metabolic profile including liver function and renal function were within normal limits. The man is an alcoholic with daily drinking. The next day, the man reported to have a headache, throat pain with some vomiting and bloody sputum noted. Repeat labs reflected normal renal function, creatinine 0.5 mg/dL, BUN 8 mg/dL. Esophagoscopy results are pending. Dr. (name), medical toxicologist, consulted per MRPC. Advised continued symptomatic and supportive care. Paraquat blood level could be checked which would be a predictor of respiratory sequalae which should show itself as pulmonary fibrosis in 1 week. This information was relayed to the nurse caring for the man. The next day follow up, it was reported the man's liver function and renal function tests remained normal. Esophagogastroduodenoscopy showed white spots in the back of the throat only. The man is able to tolerate PO fluids and advanced diet although he is still having some throat pain. The physician elected not to send off a paraquat blood level. The man was doing well and was medically cleared for discharge.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.