Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3413

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-23114141

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.

20-JUN-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

15-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)

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PMRA Registration No. 27800      PMRA Submission No.       EPA Registration No.

Product Name: Killex Lawn Weed Control Ready to Use 1L

• 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)
  • MECOPROP P-ISOMER (PRESENT AS ACID)

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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: 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.

Other

2. Demographic information of data subject

Sex: Male

Age: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Stomach pain
  • Symptom - Vomiting

4. How long did the symptoms last?

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

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

Non-occupational

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

Contact with treated area

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? children playing on residential lawn

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

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.)

1-23114141- The reporter, a parent, calls to indicate exposure of her children to an herbicide containing the active ingredients 2,4-d, mecoprop-p, and dicamba. The caller states she applied the product to her residential lawn one week prior (technique/rate not specified). 1-2 days after application she allowed her two children, a (age) male (sub-form II, #1) and (age) female (sub-form II, #2), to play on the application area. She indicates dermal contact with the application area. Her children were reported to have developed stomach pain and vomiting after dermal contact with the application area(unspecified time frame). She reports the symptoms have persisted until the point of the contact with the registrant. The caller asked if this could be related. The caller was told the symptoms described would be unexpected to be related to exposure. Re-entry following drying would be acceptable. Dermal contact with wetted product could result in mild dermal irritation alleviated by flushing the skin. The caller reported she thought her children may have a stomach flu and she would be bringing them to the doctor tomorrow. The reporter did not return callback attempts. Nothing further is known.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Stomach pain
  • Symptom - Vomiting

4. How long did the symptoms last?

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

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

Non-occupational

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

Contact with treated area

Amount of time between application and contact 2

Day(s) / Jour(s)

What was the activity? children playing on application area

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

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.)

1-23114141- The reporter, a parent, calls to indicate exposure of her children to an herbicide containing the active ingredients 2,4-d, mecoprop-p, and dicamba. The caller states she applied the product to her residential lawn one week prior (technique/rate not specified). 1-2 days after application she allowed her two children, a (age) male (sub-form II, #1) and (age) female (sub-form II, #2), to play on the application area. She indicates dermal contact with the application area. Her children were reported to have developed stomach pain and vomiting after dermal contact with the application area(unspecified time frame). She reports the symptoms have persisted until the point of the contact with the registrant. The caller asked if this could be related. The caller was told the symptoms described would be unexpected to be related to exposure. Re-entry following drying would be acceptable. Dermal contact with wetted product could result in mild dermal irritation alleviated by flushing the skin. The caller reported she thought her children may have a stomach flu and she would be bringing them to the doctor tomorrow. The reporter did not return callback attempts. Nothing further is known.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.