Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-1517
2. Registrant Information.
Registrant Reference Number: Prosar case 1-15883045
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.
11-MAR-08
5. Location of incident.
Country: UNITED STATES
Prov / State: MICHIGAN
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Sevin (non-specific)
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The reporter's friend had been using some sort of Sevin product for years in the labelled manner of use with occasional product contact.
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.
Medical Professional
2. Demographic information of data subject
Sex: Male
Age: >64 yrs / > 64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Other
- Specify - Peripheral neuropathy
4. How long did the symptoms last?
Anticip. permanent/Permanence anticipée
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
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.)
1-15883045: The reporter, a physician, called on 3/11/08 to inquire about a non-specific type of Sevin product whose active ingredient is Carbaryl. His (age) year old friend had been using this type of product for years, and had developed peripheral neuropathy. The caller was wondering if the symptoms could be incidental to occasional product contact in the labelled manner of use? The safety profile of the active ingredient was discussed, including more typical muscarinic and nicotinic signs of ataxia, incoordination, tremors, and weakness. Diagnostic cholinesterase testing was discussed, as well as the advice that the neuropathy was unlikely to be related to product use.
To be determined by Registrant
14. Severity classification.
Major
15. Provide supplemental information here.