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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3186

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-26546133

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.

17-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: Nova Scotia

6. Date incident was first observed.

17-JUN-11

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. 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

Préciser le type: lawn

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: Female

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

3. List all symptoms, using the selections below.

System

  • Respiratory System
    • Symptom - Coughing

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Application

Contact with treated area

What was the activity? contact with residential lawn/application area

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-26546133- The reporter indicated exposure to an herbicide that contained the active ingredient ammonium sops of fatty acids. The reporter indicted she was applying diluted product to her residential lawn the day prior to her initial contact with the registrant. She reported she noted a cough while applying that resolved spontaneously when she left the application area. She noted the day of her contact with the registrant that when she re-entered the application area her cough resumed only to resolve when she left the application area. The caller was advised sensitive individuals can respond to the perceived aroma of herbicides and pesticides with respiratory irritation. No harm would be expected but for the irritant effect. She was advised to minimize effects she should avoid contact with the product. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.