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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3907

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23432154

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 5, Suite 101

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N2R7

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 29301      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Path Clear Herbicidal Soap Grass Weed Killer Concentrate

• Active Ingredient(s)
  • AMMONIUM SALT OF FATTY ACID

7. b) Type of formulation.

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 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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash
  • Symptom - Hives
  • Symptom - Pruritus

• Eye
  • Symptom - Itchy eye

• General
  • Symptom - Other
  • Specify - allergic reaction

• Skin
  • Symptom - Other
  • Specify - bites

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

Non-occupational

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

Application

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.)

1-23432154- The reporter calls to indicate exposure of a family member to an herbicide containing the active ingredients ammonium salt of fatty acids. The caller, a mother, indicates both she and her [age] male child were applying the product to some paths outside her residence two days prior to the initial contact with the registrant. The caller does not describe a discreet exposure incident and stated the boy did not think he had gotten product on his skin. The caller reports her son developed hives and a rash form "head to toe" and ocular itch at some indeterminate time after product use. The caller reports she brought him to the doctor and was told the child was having and allergic response to some unknown antigen. The caller also report the young man also has "bites" (interpreted as insect bites) allover his body. She asks if this is an expected response to product exposure. The caller was advised this would be considered an unexpected response to exposure. She was advised to work with his physician in efforts to determine the cause of the symptoms and treatment. On routine call back the mother indicates her child's symptoms persisted for 3-4 days and she is still unsure of the cause of his reaction. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.