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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1490

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22037935

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. 29060      PMRA Submission No.       EPA Registration No.

Product Name: Turf Builder Weed Prevent Corn Gluten Meal Herbicide (Scotts)

  • 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).

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

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

3. List all symptoms, using the selections below.


  • Respiratory System
    • Symptom - Nasal congestion
    • Specify - "Congested"
  • Nervous and Muscular Systems
    • Symptom - Headache

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)


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.)

1-22037935: A reporter called on 03/24/2010 to report his exposure to an herbicide containing the active ingredient corn gluten meal. According to the reporter, he just realized that mice had created a nest out of the product in his car's heating ducts and that he had been driving around with the blower on and inhaling the product dust. The reporter states that he is more congested than usual and gets more headaches. At the time of the report, the product had been removed from the car by a mechanic. The reporter was advised that if there was a strong odor to the product, headache, nausea, and respiratory irritation may result. The signs are typically self-limiting and resolve with removal from the odor. The reporter was also advised that the product has low toxicity, and adverse effects may result from either the odor or the dust from the product causing respiratory irritation. A recommendation was made for the reporter to see his physician should his signs persist. No further information was obtained.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.