Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-4661
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-14865554
Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC
Address: 14111 Scottslawn Road
City: Marysville
Prov / State: Ohio
Country: USA
Postal Code: 43041
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
03-MAY-07
5. Location of incident.
Country: UNITED STATES
Prov / State: ILLINOIS
6. Date incident was first observed.
23-APR-07
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. 228424239
Product Name: Weed-B-Gon MAX Concentrate
- Active Ingredient(s)
- DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
- Guarantee/concentration 1.35 %
- MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)
- Guarantee/concentration 13.72 %
- TRICLOPYR TRIETHYLAMINE SALT
- Guarantee/concentration 1.56 %
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
150
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
- Nervous and Muscular Systems
- Skin
- Symptom - Pale mucous membrane colour
- Specify - gums/ears whitened
- Respiratory System
- Symptom - Shortness of breath
- Blood
- Symptom - Thrombocytopenia
12. How long did the symptoms last?
Persisted until death
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
Not recovered / Non rétabli
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
Dog was witnessed eating grass from the treated areas on 04/23/07. Product had been applied on 4/21/07. Symptoms noted on 4/24/07, vomiting, Shortness of Breath, Whitened gums and ears, Ataxia. Has a RBC of 8. Currently at the Veterinarian. Product was mixed at 1c to 1gal water Follow-up information received on 05/08/07. Dog passed away on 5/4/07, states RBC count was really low, Veterinarian offered a blood transfusion but owner stated he could not afford that. Decision was to allow the pet to pass away at home.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here