Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-2255
2. Registrant Information.
Registrant Reference Number: PROSAR 1-22331452
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.
Domestic Animal
4. Date registrant was first informed of the incident.
21-APR-10
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
21-APR-10
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. 29060
PMRA Submission No.
EPA Registration No.
Product Name: Turf Builder Lawn Fertilizer 10-0-0 with Weed Prevent
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 on 4/18/10 and the patient developed symptoms on 4/21/10.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Miniature Poodle
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
15
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify There was no witnessed exposure.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-22331452: The reporter, an animal owner, notified the registrant on 4/21/10 of the exposure of a 3 year old female Miniature Poodle to a fertilizer/herbicide product containing the active ingredient Corn Gluten meal. According to the reporter, the product had been applied on 4/18/10. The dog had developed ¿¿¿yellow¿¿¿ diarrhea the day of the call. The caller inquired about the nature of the product and wondered if it represented any harm. The reporter was advised that ingestions of the product could cause minor GI irritation, which should be managed with fluid replacement therapy as needed. Veterinary care should be sought if symptoms persisted. A follow-up call was placed but was not returned. No additional details are available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here