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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3452

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23538100

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 27521      PMRA Submission No.       EPA Registration No.

Product Name: Ortho Home Defense Max Perimeter Indoor Insect Control Ready-to-Use

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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?


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.


  • Nervous and Muscular Systems
    • Symptom - Dizziness
  • Gastrointestinal System
    • Symptom - Nausea
  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Specify - loss of motor control
    • Symptom - Difficulty walking
    • Specify - couldn't raise foot up

4. How long did the symptoms last?

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

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


6. a) Was the person hospitalized?


6. b) For how long?


Day(s) / Jour(s)

7. Exposure scenario


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

Contact with treated area

What was the activity? contact with furniture to which product had been applied

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


10. Route(s) of exposure.


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.)

1-23538100- The reporter calls to indicate exposure to an insecticide containing the active ingredient permethrin. The reporter indicates he applied the product to his residential home and inside his vehicle fifteen days prior to the initial contact with the registrant. The reporter indicates he may have sat on furniture with still wet product applied. The caller does not, however, describe a discreet exposure incident. The caller reports two days after the initial application he developed symptoms of nausea, vertigo, and ¿lack of motor control" further described as he "could barely walk". He reports by the following day he was brought to the emergency room by ambulance and reports the doctors contacted regional poison control. The physicians were told by poison control the symptoms seen were inconsistent with exposure to this active ingredient. The reporter indicates he was hospitalized for the next nine days during which time he had blood tests (unspecified), a CT scan and many other unspecified tests all of which were reported to be within normal limits. The caller reports he was given no actual treatment during his stay in the hospital. The caller was advised the symptoms seen would not be expected following routine product use. He was advised of the low order of toxicity and concentration of the product. He was advised of topical symptoms that may be seen following immediately dermal contact and appropriate treatment/decontamination. He was advised to follow with his doctor for further treatment/diagnosis. The reporter did not respond to two separate follow up attempts. No further information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.