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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4729

2. Registrant Information.

Registrant Reference Number: Prosar 1-20520491

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 24224      PMRA Submission No.       EPA Registration No.

Product Name: Bug-B-Gon Hornet and Wasp Blaster

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The product was applied into a hollow space on the exterior of the garage in 08/2009. Following product application, a non-company product (Raid Foaming Ant Killer) was also sprayed into the area.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Headache
    • Symptom - Difficulty concentrating

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


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.)

1-20520491: A reporter called on 10/24/2009 to report his exposure to an insecticide containing the active ingredients Pyrethrins, Piperonyl butoxide, NOBD, and Propoxur. According to the reporter, the product was applied into a hollow space on the exterior of the garage in 08/2009. Following product application, the reporter sprayed a non-company product (Raid Foaming Ant Killer) into the space. The reporter stated that the product fumes drifted into his bedroom and he developed a headache and difficulty concentrating when he slept in that room. The fumes are no longer present in the bedroom, but he still experiences symptoms when he sleeps in there. The odor still lingers a bit at the application site, and the reporter applied baking soda to the area to try to neutralize it. The reporter was advised that strong or unpleasant odors may result in headache, but difficulty concentrating would not be expected. Inhalation of product mist may cause respiratory irritation such as coughing, difficulty breathing, or shortness of breath. No signs are anticipated once the product is dry and the odor has dissipated. A recommendation was made to clean the treated area with a mild dish detergent and water to see if that removes the odor. A recommendation was also made to have his persistent signs evaluated by a physician and to make sure there is nothing else in the room that may be contributing to the reporter's signs. No further information was obtained.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.