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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3362

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-23312135

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.

01-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

29-JUN-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. 22027      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max No Pest Insecticide Strip

  • Active Ingredient(s)
    • DICHLORVOS PLUS RELATED ACTIVE COMPOUNDS

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).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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

  • Gastrointestinal System
    • Symptom - Nausea

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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

Contact with treated area

What was the activity? Product, a pesticide strip, was hung in the residential home

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?

>24 hrs <=3 days / >24 h <=3 jours

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-23312135- The reporter calls to indicate exposure to a pesticide containing the active ingredient dichlorvos. The reporter indicates he had hung the product, a pesticide strip, in his residential home some 48 hours before the initial contact with the registrant. He reports symptoms of nausea for the same time frame, but does not clearly indicate the onset of the symptom with respect to the application time. The caller cited potential inhalation fumes associated with the product as the mode of exposure. The caller was advised the active ingredient has low order of toxicity as described. Minimal active ingredient would be expected to be delivered to the body via inhalation of fumes. The caller was advised the product is not labeled for use in inhabited areas. Per the label this product should not be used in the home except in garages, attics, crawl spaces and sheds occupied less than 4 hours per day. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.