Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-3755

2. Registrant Information.

Registrant Reference Number: PROSAR case 1-16460627

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 5, Suite 101

City: Mississauga

Prov / State: Ontario

Country: USA

Postal Code: L5N2R7

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

29-JUL-08

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

28-JUL-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. 9167      PMRA Submission No.       EPA Registration No.

Product Name: Ant-B-Gon Max Ant Killer Liquid (Ortho)

  • Active Ingredient(s)
    • BORAX

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).

Reporter stated that he applied the product on 7/27/2008.

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: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • General
    • Symptom - Swelling
  • Skin
    • Symptom - Paresthesia
    • Specify - Paraesthaesia

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

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.

Skin

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

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.)

1-16460627: The reporter called on 7/29/2008 to report exposure to an insecticide containing the active ingredient Borax. According to the reporter, he applied the product on 7/27/2008 and got a small amount on his hands. Approximately ¿ hour after application, the reporter washed his hands. The next day the reporter¿s hands were swollen with paresthaesia. The swelling was worse on the left hand in close proximity to a scar. At the time of the call, the reporter¿s right hand was improved, but the left hand was still swollen. The safety profile of the product was discussed in that skin exposure may result in irritation and redness which should gradually subside following irrigation. Recommendations were made to apply a cold compress or vitamin E/aloe vera containing products. Additionally, hydrocortisone or Benadryl cream could be used for itching provided there were no open sores. If symptoms persisted or worsened over a 24 hour period, it was recommended that the reporter seek medical attention. Follow-up attempt was unsuccessful. No further information was reported.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.