Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2531
2. Registrant Information.
Registrant Reference Number: Prosar 1-18703218
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.
04-JUN-095. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
31-MAY-09Product 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: (discontinued) Turf Builder Plus 2 Lawn Fertilizer 28-3-3/Weed Control
- Active Ingredient(s)
- 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
- AMMONIUM SULPHATE
- MECOPROP P-ISOMER PRESENT AS DIMETHYLAMINE SALT
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).
The product was applied on 05/31/2009 or 06/01/2009.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
- Skin
- Symptom - Burning skin
- Symptom - Skin sensitivity
- Symptom - Irritated skin
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
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
11. What was the length of exposure?
Unknown / Inconnu
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.)
1-18703218: A reporter called on 06/04/2009 to report her exposure to a fertilizer containing the active ingredients 2,4-D, Mecoprop, and Ammonium Sulfate. According to the reporter, she was breaking up chunks of the product with her bare hands on 05/31/2009 or 06/01/2009. She washed her hands immediately following exposure. Since that time, her hands have been burning off and on and have been more sensitive to warm water. The reporter was advised that the product may result in dermal irritation that generally subsides following irrigation. A recommendation was made to apply vitamin E oil or aloe vera to the skin to help soothe the irritation. It was also recommended that the caller seek medical evaluation should the signs persist or worsen. On follow up, the reporter stated that the occasional irritation was persistent and that she was applying vitamin E oil. The reporter mentioned that she had also used bleach the same day she used the product which may have contributed to the irritation. A recommendation was made to see her health care provider for any persistent signs. No further information was provided.
To be determined by Registrant
14. Severity classification.
Minor
