Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5368

2. Registrant Information.

Registrant Reference Number: Prosar 1-20725323

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.

13-NOV-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 22027      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max No-Pest Insecticidal Strip (Ortho)

• Active Ingredient(s)
  • DICHLORVOS PLUS RELATED ACTIVE COMPOUNDS

---

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. - In Home / Rés. - à l'int. maison

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

The product was cut into strips and placed inside the home 2 weeks 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: Female

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Respiratory System
  • Symptom - Shortness of breath

• Gastrointestinal System
  • Symptom - Diarrhea

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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

Drift from the application site

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

Respiratory

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.)

1-20725323: A reporter called on 11/13/2009 to report her exposure to an insecticide containing the active ingredient Dichlorvos. According to the reporter, the product was cut into small pieces and applied inside the home 2 weeks prior to the report. The reporter developed dizziness, shortness of breath, and increased diarrhea at an unknown time following product exposure. She went to the emergency room on 11/12/2009. Non-specific diagnostics were performed but no diagnosis was made. The reporter was advised that the product contains an organophosphate. Signs of organophosphate toxicity were discussed. A recommendation was made to discuss cholinesterase testing with her physician to rule out product involvement. An attempt at follow up was unsuccessful. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.