Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3411

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-23004071

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.

13-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2217-896-239

Product Name: Weed-B-Gon MAX Plus Crabgrass Control Ready Spray

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)

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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 caller indicates her husband sprayed the diluted product two weeks prior to the call, she did not say in what capacity or specify application rate.

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: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Liver
  • Symptom - Other
  • Specify - liver "issues" unspecified

• Renal System
  • Symptom - Other
  • Specify - "Renal issues" not specified

• Gastrointestinal System
  • Symptom - Other
  • Specify - Pancreatic "issues"

• Skin
  • Symptom - Rash

• Respiratory System
  • Symptom - Shortness of breath

• Skin
  • Symptom - Jaundice

• Blood
  • Symptom - Hyperglycemia
  • Symptom - Other
  • Specify - splenic "issues"

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

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.

Skin

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-23004071- The reporter calls to indicate her husband may have been exposed to an herbicide containing the active ingredients 2,4-D and dicamba. The caller indicated her husband was spraying the diluted product 2.5 weeks prior to the initial contact with the registrant. She did not indicate in what capacity he was spraying or the application rate. She did not describe a discreet exposure but posits possible dermal or inhalation exposure during application. The caller indicated during the initial call her husband had been admitted into the hospital, ill for 2 weeks, and they were ¿¿¿grasping at straws¿¿¿ to determine the etiology. The caller reported her spouse had developed symptoms of shortness of breath, generalized jaundice, and rash on both of his legs at an unspecified time frame following the exposure. She also indicated liver, splenic, pancreatic, and renal ¿¿¿issues¿¿¿ of an unspecified nature. The caller stated she initially had thought he had developed the ¿¿¿flu¿¿¿. The caller at the initial call indicated four specialists had evaluated her husband and had been unable to determine the cause of his illness. The caller was told the diluted product if encountered via the dermal and respiratory routes would be mainly expected to produce mild self-limiting irritation to those body surfaces. No systemic effect, as described, would be expected. On routine call back the reporter indicated her husband was still hospitalized. His liver, kidneys and pancreas were still ¿¿¿out of whack¿¿¿ to use her words. He had daily blood work run (unspecified). She reported his rash had resolved and jaundice was resolving. The caller indicates no definitive diagnosis had been reached but the doctors believe his symptoms may be an adverse reaction to an antibiotic he had been taking (Septra). The caller, further, stated his blood sugar had been running high (it was added he was diabetic) but this was being controlled with insulin. No further information is available on this case.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.