Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3323

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-44004530

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.

04-MAY-16

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

04-MAY-16

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.       PMRA Submission No.       EPA Registration No. 228424239

Product Name: ORTHO WEED B GON WEED KILLER FOR LAWNS READY TO SPRAY

• Active Ingredient(s)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)
  • TRICLOPYR TRIETHYLAMINE SALT

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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.

Other

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Red skin

4. How long did the symptoms last?

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

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)

Other

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.

Skin

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.)

1-44004530 - The reporter indicated her husband was exposed to a herbicide containing the active ingredients dicamba (present as acid, amine salt, ester, or sodium salt), triclopyr triethylamine salt, and MCPA (present as amine salts diethanolamine, dimethylamine, or mixed amines). The reporter said her husband spilled some of the product on his wrist right before initial contact with the registrant. Her husband immediately washed off the area but now the area is red. The reporter was advised to have her husband rinse the area for 20 minutes with tap water and seek medical attention if symptoms persist. On a follow-up call one day after initial contact, the reporter said her husband symptoms had resolved. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.