Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5687

2. Registrant Information.

Registrant Reference Number: 32183505

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: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

27-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. 524-537

Product Name: Roundup WeatherMax

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS POTASSIUM SALT)

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7. b) Type of formulation.

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Chest pain

• Respiratory System
  • Symptom - Difficulty Breathing

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Trembling

• General
  • Symptom - Other
  • Specify - violently ill

• Eye
  • Symptom - Other
  • Specify - looks poisoned

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

Drift from the application site

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.

Unknown

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.)

Adult (age) year old male was working in his garden and sweet corn when the field adjoining his within several feet was sprayed during 15 mile per hour winds with Roundup WeatherMax. He was in the path of the wind and noticed a very strong smell but did not become wet with the product. He showered several hours later. He reports, soon after the exposure, he became "violently ill, with chest pain, headache, vomiting for 24 hours. He is now having tremors in his fingers and his breathing seems affected. He had a medical evaluation and was given a salmeterol inhaler. Blood testing was done. He was told that his eyes look like he was poisoned. Today every muscle in his body aches. Advised to continue under the care of PMD. MRPC is available to speak with MD if desired.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.