Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-1492

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22025982

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.

24-MAR-10

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

16-SEP-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)

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PMRA Registration No. 28208      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max Indoor Insect Control Aerosol formerly Creepy Crawly

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PERMETHRIN
  • PYRETHRINS

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

Product Name: Raid

• Active Ingredient(s)

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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 applied inside a residence in 09/2009. A non-company insecticide (Raid) was applied at the same time.

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 - Paresthesia
  • Specify - "Electrical sensation"

• Ear
  • Symptom - Tinnitus
  • Specify - "Ringing in the ears"

• Eye
  • Symptom - Other
  • Specify - "Flashes of light"

• Nervous and Muscular Systems
  • Symptom - Seizure

4. How long did the symptoms last?

>6 mos / > 6 mois

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? Inhalation of product odor

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

1-22025982: A reporter called on 03/24/2010 to report the exposure of herself and her mother to an insecticide containing the active ingredients Pyrethrins, Permethrin, and NOBD. According to the reporter, the reporter's mother sprayed the product and the non-company product Raid in 09/2009. The reporter walked into the treated area and smelled the odor of the product. Two weeks following the exposure, the reporter (1st Subform II) and her mother (2nd Subform II) both developed signs of electrical sensation, ringing in the ears, flashes of light, and seizures. The reporter and her mother saw a neurologist, but a diagnosis was not made. The signs were still occasionally occurring at the time of the report. The reporter was advised that the signs described are not expected following the described exposure to the product. Inhalation of product mist may result in upper respiratory tract irritation including cough, difficulty breathing, and shortness of breath. Eye irritation may also occur. All signs are expected to resolve without affecting any other body system. Ingestion of large amounts of product may result in gastrointestinal signs and more rarely, neurologic signs. The signs described are not consistent with inhalation of product odor. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Paresthesia
  • Specify - "Electrical sensation"

• Ear
  • Symptom - Tinnitus
  • Specify - "Ringing of ears"

• Eye
  • Symptom - Other
  • Specify - "Flashes of light"

• Nervous and Muscular Systems
  • Symptom - Seizure

4. How long did the symptoms last?

>6 mos / > 6 mois

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

Contact with treated area

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

1-22025982: A reporter called on 03/24/2010 to report the exposure of herself and her mother to an insecticide containing the active ingredients Pyrethrins, Permethrin, and NOBD. According to the reporter, the reporter's mother sprayed the product and the non-company product Raid in 09/2009. The reporter walked into the treated area and smelled the odor of the product. Two weeks following the exposure, the reporter (1st Subform II) and her mother (2nd Subform II) both developed signs of electrical sensation, ringing in the ears, flashes of light, and seizures. The reporter and her mother saw a neurologist, but a diagnosis was not made. The signs were still occasionally occurring at the time of the report. The reporter was advised that the signs described are not expected following the described exposure to the product. Inhalation of product mist may result in upper respiratory tract irritation including cough, difficulty breathing, and shortness of breath. Eye irritation may also occur. All signs are expected to resolve without affecting any other body system. Ingestion of large amounts of product may result in gastrointestinal signs and more rarely, neurologic signs. The signs described are not consistent with inhalation of product odor. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.