Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5099

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-41750840

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

Address: 2000 Argentia Road, Plaza 2, Suite 300

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N1V8

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

Human

4. Date registrant was first informed of the incident.

31-AUG-15

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

31-AUG-15

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. 30557      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max, Hornet/Wasp Eliminator Spray

• Active Ingredient(s)
  • D-PHENOTHRIN
  • TETRAMETHRIN

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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. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Reporter indicated that he sprayed the hornet and wasp killer throughout the inside of his home.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Lethargy

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Contact with treated area

Amount of time between application and contact 2.5

Hour(s) / Heure(s)

What was the activity? Daily living

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.

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.)

1-41750840 - The reporter, a home owner, indicated that his mother was exposed to an insecticide containing the active ingredients phenothrin and tetramethrin. The reporter applied the product throughout the inside of his home 2-3 hours prior to initial contact with the company and thirty minutes prior to contact his mother vomited. The reporter was advised that inhalation of the fumes may cause short-term nausea. Fresh air and ventilation of the home was recommended. On follow-up call, two days later, the patient indicated that she also developed diarrhea, a headache and felt very tired. The symptoms resolved spontaneously after 12 hours. No medical attention was needed. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.