Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3830

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23629850

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.

29-JUL-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

29-JUL-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. 28179      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Path Clear Weed Control Spray with Pull N Spray Applicator

• Active Ingredient(s)
  • ACETIC ACID

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

• General
  • Symptom - Malaise

• Cardiovascular System
  • Symptom - Hypotension

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

Non-occupational

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

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

1-23629850- The reporter calls to indicate exposure of a family member to an herbicide containing acetic acid. He caller indicates his wife was using the product one hour prior to initial contact with the registrant (unspecified capacity or rate). He indicates dermal contact and rinsing/decontamination following working with the product. He indicates at the point of the call his wife did not feel well (malaise) and had low blood pressure. The caller was advised dermal irritation may be seen dermal contact but the symptoms described would not be expected. On routine call back the reporter advised the registrant his wife suffered from heat stroke that day and her symptoms were unrelated to the product use. She was at that point asymptomatic. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.