Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3879
2. Registrant Information.
Registrant Reference Number: Prosar 1-19574689
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.
19-AUG-09
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
18-AUG-09
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: Ecosense Brand Natural Grass/Weed Killer Ready to Spray
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 to the lawn "a few days" prior to the report.
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
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)
Contact with treated area
What was the activity? pulling weeds
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.)
1-19574689: A reporter called on 08/19/2009 to report his exposure to an herbicide containing the active ingredient Soybean Oil. According to the reporter, the product had been applied to the lawn a few days prior to the report. On 08/18/2009, the reporter was wearing sandals and pulling weeds in the treated area. Shortly after pulling the weeds, the reporter developed an itching sensation on the bottom of his feet. The reporter washed his feet several times but the signs persisted. The reporter was advised that the signs described are not expected with routine use of the product. The reporter was also advised that individuals may have an unrecognized sensitivity to an ingredient in the product, or the signs may be unrelated to product exposure. A recommendation was made to consider the use of an over-the-counter hydrocortisone cream to relieve the itching. The reporter was advised that he should seek medical attention should his signs persist longer than 72 hours or worsen. Several attempts at follow up were unsuccessful. No further information was obtained.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.