Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-8331
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-15069930
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd
Address: 2000 Argentia Road, Plaza 5, Suite 101
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N2R7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
03-JUL-075. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
01-JUL-07Product 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. 27801 PMRA Submission No. EPA Registration No.
Product Name: Killex Lawn Weed Control Concentrate (Ortho)
- Active Ingredient(s)
- 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
- DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
- MECOPROP P-ISOMER PRESENT AS DIMETHYLAMINE SALT
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 III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Bird / Oiseau
3. Breed
Unknown Breed Exotic Bird
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Malaise
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify Unknown Exposure route
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Case Received for documentation and follow-up from Consumer services on 7/3/07 E-mail Received: Ref [#] I have just sprayed my lawn with "Killex" 500mlthe day was muggy and calm. My neighbor just came over and said his exotic bird is very ill he just spent $400.00 at the vet who said the product would probably have been the cause. The bird was in their house with the windows open. Additional contact on 7/04/07 Caller says her family is new to the neighborhood. Says they applied product (diluted) to their lawn two days ago (7/1). Caller's neighbor reports to them that, according to his (the neighbor's) DVM, his small, unknown breed exotic bird was harmed (neighbor offered no specific Symptoms, unknown condition of the bird at this time) by the product. Caller denies any exposure to the product - says the bird had been indoors. Caller also states the neighbor is doing cement work on his home. Caller phones H+SI after response from e-mail to Scotts regarding incident. Assessment: Advised caller H+SI would not suspect product as cause of any Symptoms as no exposure to product is described. Caller to forward case # to neighbor - have DVM contact H+SI if there are any other questions. Note: PMRA: 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
18. Severity classification (if there is more than 1 possible classification
Minor
