Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-5759

2. Registrant Information.

Registrant Reference Number: ProPharma Group case 1-45301603

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.

19-AUG-16

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

Unknown

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. 28208      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HOME DEFENSE MAX INDOOR INSECT CONTROL AEROSOL

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PERMETHRIN
  • PYRETHRINS

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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: Pub. Area - Indoor/Zone publique - int

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 - Tingling skin
  • Symptom - Pruritus

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

Occupational

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

Contact with treated 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.

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.)

1-45301603 - The reporter indicated her husband may have been exposed to an insecticide containing the active ingredients permethrin, pyrethrins, and N-octyl bicycloheptene dicarboximide. On the day of initial contact with the registrant, the reporter stated her husband had sprayed the product inside his office two days before initial contact with the registrant. She stated her husband experienced itching and tingling of his skin whenever he was at the office. For the last two days, the symptoms would go away once he was at home and showered, only to return once he went back to the office. The reporter was advised that exposure to the wet product may cause parasthesia, but this should not occur once the product was dried. The reporter was instructed to clean the areas of the office where the product was sprayed. The reporter was unable to be reached on follow-up call four days later. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

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

• Skin
  • Symptom - Tingling skin
  • Symptom - Pruritus

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

Occupational

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

Contact with treated 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.

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.)

1-45301603 - The reporter indicated her husbands coworker may have been exposed to an insecticide containing the active ingredients permethrin, pyrethrins, and N-octyl bicycloheptene dicarboximide. On the day of initial contact with the registrant, the reporter stated her husband had sprayed the product inside his office two days before initial contact with the registrant. She stated her husbands coworker experienced itching and tingling of her skin whenever she was at the office. For the last two days, the symptoms would go away once she was at home and showered, only to return once she went back to the office. The reporter was advised that exposure to the wet product may cause parasthesia, but this should not occur once the product was dried. The reporter was instructed to clean the areas of the office where the product was sprayed. The reporter was unable to be reached on follow-up call four days later. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.