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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3188

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-26587450

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.

22-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-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. 29303      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Moss B Gon Herbicidal Soap Moss Algae 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: Male

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

3. List all symptoms, using the selections below.

System

  • Gastrointestinal System
    • Symptom - Nausea
  • Nervous and Muscular Systems
    • Symptom - Headache
  • General
    • Symptom - Chills
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
    • Symptom - Muscle cramps

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

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.

>24 hrs <=3 days / >24 h <=3 jours

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.)

1-26587450-The reporter indicated he had potentially been exposed to an herbicide containing the active ingredient ammonium soaps of higher fatty acids. The reporter indicated he had been applying diluted product to his residential lawn four days prior to his initial contact with the registrant. The reporter stated he had experienced the symptoms of weakness, headache, muscle cramps, chills, and nausea within 36 hours of product use. The caller did not describe a discreet exposure incident but indicated possible inhalation exposure. The caller was advised the time line, symptoms and mode of exposure were inconsistent with the toxicity profile of the active ingredient. He was advised to seek medical attention to help him determine the cause of his symptoms and appropriate care. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.