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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2928

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-22829238

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.

31-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

31-MAY-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. 29269      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Bug B Gon Insecticidal Soap with Pull N Spray Applicator

  • Active Ingredient(s)
    • POTASSIUM SALTS OF FATTY ACIDS

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: Unknown / Inconnu

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

The patient received an accidental spray of the product in her eye.

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.

Other

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Irritated eye

4. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

No

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

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

Unknown

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.

Eye

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-22829238: The reporter called on 5/31/10 to report the exposure of his wife to a pesticide product containing the active ingredient Fatty acids of potassium salts. According to the reporter, his wife had received an accidental spray of product in her eye 15 minutes prior to the call. She had irrigated her eye but it still felt as though something was present in the eye. During the 5/31 call the safety profile of the product was discussed (irritant), and a recommendation was made to fully rinse the eye with tepid tap water for 15-20 minutes. The reporter was advised to not instill any over-the-counter eye drops into the patient¿s eyes. It was also recommended that the patient should be seen by a health care provider if symptoms persisted for more than 6 hours or worsened in severity. Contact with the patient on 6/2/10 revealed that her symptoms had lasted only 2 hours. No physician was contacted.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.