Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-8363
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-15287225
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.
Human
4. Date registrant was first informed of the incident.
05-SEP-07
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
05-SEP-07
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. 28258
PMRA Submission No.
EPA Registration No.
Product Name: Home Defense Max Perimeter + Indoor Insect Control with Pull N Spray
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. - 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?
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
- Gastrointestinal System
- Symptom - Irritated throat
- Symptom - Salivating excessively
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
No
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
Oral
11. What was the length of exposure?
<=15 min / <=15 min
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.)
History: Caller was spraying the product in her windows to kill some spiders 25 min ago. She got some of the over spray on her face and some of the over spray blew back into her mouth from the wind. Is now salivating more than usual, and has throat irritation. Has drunk 2 glasses of water. Assessment: - Discussed with the caller: - Small ingestions of this product are unlikely to result in adverse health effects other than mild GI upset or the parathesia type symptoms. - Recommend milk or water to drink, ice cubes to suck on or something to eat.. - If nausea, vomiting, or diarrhea develops, replace lost fluids. - Wash your hands and face with soap and water. - If symptoms persist or worsen seek medical attention. - Please call back with any additional questions or concerns. Note: Based on the toxicologic profile of the product and the alleged contact/effect in the incident description, the symptoms alleged would be consistent with what would be expected from the described product contact.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.