Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4646

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15087806

Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC

Address: 14111 Scottslawn Road

City: Marysville

Prov / State: Ohio

Country: USA

Postal Code: 43041

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

Human

4. Date registrant was first informed of the incident.

04-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

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.       PMRA Submission No.       EPA Registration No. 239-2657

Product Name: GroundClear Complete Vegetation Killer - EPA: 239-2657

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Guarantee/concentration 8 %
  • IMAZAPYR
    • Guarantee/concentration .08 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 71995-29

Product Name: Roundup Weed & Grass Plus Diquat Conc. - EPA 71995-29

• Active Ingredient(s)
  • DIQUAT
    • Unknown
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)
    • Unknown

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7. b) Type of formulation.

Liquid

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.

Other

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Tongue swelling

• Respiratory System
  • Symptom - Respiratory irritation
  • Symptom - Other
  • Specify - Partially Collapsed Lung
  • Symptom - Asthma

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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.

Unknown

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.)

E-mail Case Received on 06/04/07 (No further information available) Husband mixed roundup w&g killer with groundclear, went to the hospital for respiratory Problems. Dr. treated him for asthma, he has a swollen tongue, problems breathing and the lower portion of one of his lungs collapsed. Going to call dr back, didn't want to speak with poison control, would like MSDS to be faxed to dr. Note: Given the limited history provided, the relationship between the alleged contact and the effect in the incident description is indeterminable.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.