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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3361

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-23279872

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.

30-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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. 29272      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Bug B Gon Insecticidal Soap Concentrate Ready to Spray

  • 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: 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).

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

  • Gastrointestinal System
    • Symptom - Mouth Irritation

4. How long did the symptoms last?

Unknown / Inconnu

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)

Application

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.

Oral

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.)

1-23279872- The reporter calls to indicate exposure to an insecticide containing the active ingredients potassium salt of fatty acids. The caller stated she applied the product to some plants three weeks prior to the initial contact with the registrant. She may have gotten some product in her mouth at that time. She reports currently she has experienced oral irritation. She reports the roof of her mouth and the area behind her teeth are raw. The caller was advised no harm would be expected to occur following small ingestions of the product. The caller was advised the occurrence of symptoms three weeks following potential exposure would not be expected. The caller was advised to seek medical care to assisting diagnosis and treatment. The caller was unavailable on routine call back. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.