Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2930

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-22487045

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.

04-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

04-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. 21635      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Garden Insecticide Spray

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
    • PYRETHRINS

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 reporter accidentally sprayed the product into his face. Multiple routes of exposure - ocular, oral, possible inhalation as well.

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: Male

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

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Irritated eye
    • Symptom - Red eye
  • Skin
    • Symptom - Pruritus

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 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)

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

Eye

Respiratory

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.)

1-22487045: The reporter called on 5/4/10 to report his exposure to a lawn and garden product containing the active ingredients Pyrethrins and Piperonyl Butoxide 10 minutes prior to the call. The reporter indicated he had accidentally sprayed some of the product onto his face, and had gotten it in his eyes and mouth. The reporter also felt that he may have inhaled some of the product. By the time of the call he had already rinsed his eyes and mouth with water. He complained of some ocular redness and irritation but was otherwise asymptomatic. The safety profile of the product was discussed in terms of its potential to act as an irritant. A recommendation was made to rinse the eyes with lukewarm tap water or normal saline for at least 15 to 20 minutes; to not use any over-the-counter eye drops, and to seek medical attention if the symptoms persisted for more than 6 hours or worsened in severity. A follow-up call on 5/5 revealed that the reporters symptoms had totally resolved. He had repeatedly washed his eyes and rinsed his mouth on 5/4 for decontamination. Additional symptoms had developed later in the day pruritis of the head, face, ears and eyes. The reporter treated these symptoms with over the counter Tylenol cold medicine (with an antihistamine); the symptoms lasted for a total of 3 hours.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.