Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3109
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16364771
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.
06-JUL-08
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
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. 28379
PMRA Submission No.
EPA Registration No.
Product Name: Ecosense Insecticide Ready to Use (Scotts)
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
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.
Medical Professional
2. Demographic information of data subject
Sex: Female
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Respiratory System
- Symptom - Irritated throat
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Pesticide Spill
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
10. Route(s) of exposure.
Respiratory
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.)
1-16364771: The reporter, a health care professional, called on 7/6/08 to report the exposure of a female patient to a product containing the active ingredient Pyrethrin. According to the reporter, the exposure had occurred at the patient¿s workplace - a garden center. The product had spilled after it had fallen off a shelf and the patient had inhaled some of the fumes. The patient had developed throat irritation. The safety profile of the product was discussed including the fact that inhalation may lead to transient upper respiratory irritation. No long term symptoms or side effects would be anticipated. A recommendation was made to provide symptomatic and supportive care. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.