Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3990

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-44345366

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.

03-JUN-16

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

03-JUN-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)

PMRA Registration No. 28178      PMRA Submission No.       EPA Registration No.

Product Name: SCOTTS ECOSENSE PATHCLEAR GRASS & WEED CONTROL SPRAY WITH QUICK CONNEC

  • Active Ingredient(s)
    • ACETIC 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: Female

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

3. List all symptoms, using the selections below.

System

  • Respiratory System
    • Symptom - Coughing
    • Symptom - Irritated throat

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.

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.

Skin

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.)

1-44345366 - The reporter indicates an exposure to an herbicide containing the active ingredient acetic acid. On the day of initial contact with the registrant, the reporter stated she was spraying the product and a gust of wind blew the product into her face. The reporter rinsed her mouth and face, but reports a cough and throat irritation. The reporter was advised to thoroughly rinse the product from her face as the product can cause respiratory irritation, and to seek medical attention of the symptoms persisted. A follow-up call four days after initial contact revealed the symptoms lasted for 2 days. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.