Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3753
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-16163269
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Agentia 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.
19-MAY-08
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
19-MAY-08
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: Killex (Non-specific)
- 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 (PRESENT AS AMINE SALTS)
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).
Reporter applied product on 5/18/2008
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Dachshund
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
30
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Skin
- Symptom - Burning skin
- Specify - Feels hot
- General
- Symptom - Lethargy
- Symptom - Restlessness
- Gastrointestinal System
- Symptom - Melena
- Symptom - Anorexia
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 Pet walked on treated area and may have licked product off its body
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16163269: The reporter called on 5/19/2008, to report possible exposure of her dog to a herbicide product containing the active ingredients of 2,4-D, Dicamba and Mecoprop-P. According to the reporter, the product was applied on 5/18/2008 and the pet walked on it. The next morning, the dog was wheezing, lethargic, restless, anorexic, felt hot and had melena (black diarrhea). The reporter thought the dog may have licked the product off its body. The safety profile of the product was discussed in that the symptoms would not be expected with the described exposure. GI irritation may occur with ingestion but it would be expected to be self-limiting. It was also relayed that the symptoms could be due to a non-related medical condition. A recommendation was made to seek veterinary care should symptoms persist or worsen. Follow-up attempts were unsuccessful, no further information was provided.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here