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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6523

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15217123

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: KENTUCKY

6. Date incident was first observed.


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.


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

Product Name: Ant-B-Gon Dust - EPA: 1021-1749-239

  • Active Ingredient(s)
      • Guarantee/concentration .25 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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).

To be determined by Registrant

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


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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Unconsciousness
    • Symptom - Headache
  • Cardiovascular System
    • Symptom - Hypertension
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

History: Every spring she gets ants and this year she sprinkled the product out into the ducts in her house. She did that and it killed all of the ants. Within the last 2-3 months she started getting sick. She started having problems with her memory and was blacking out for short periods of time. One night in the middle of the night she jumped out of bed in pain. A couple nights later she had a headache and thought she was going to have an aneurysm. She took one ASA and that didn't help. She took another 2 a couple of hours later and called her daughter. She took her to the MD and her BP was 240 over something high. Friday night (8/10) she was very weak and went to her daughter's apartment and about 2 hours later she started feeling much better since she was out of the house. Her daughter came over later and said that something smelled funny in the house. She is worried about her internal organs being poisoned by this product. She correlated the product causing her to be ill when she realized she felt much better when she was out of the house. They have had the ducts cleaned out and she feels much better now. She has remained asymptomatic since the ducts were cleaned. Assessment: - This is not an expected result of product use in the home - Would not expect the product exposure to have caused the symptoms you've described - Happy to hear you are feeling better - Please have your MD call with questions about the product. - Callback with additional questions/concerns Note: Based on the toxicologic profile of the product and the alleged contact/effect in the incident description, the symptoms alleged would be inconsistent with what would be expected from the described product contact.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.