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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3908
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23476159
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.
16-JUL-105. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
16-JUL-10Product 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. 24265 PMRA Submission No. EPA Registration No.
Product Name: Green Cross Killex RTU
- 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 (PRESENT AS DIETHANOLAMINE SALT)
- MECOPROP (PRESENT AS DIMETHYLAMINE SALT)
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
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.
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
- Respiratory System
- Symptom - Irritated throat
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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)
Other
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?
<=15 min / <=15 min
12. Time between exposure and onset of symptoms.
>8 hrs <=24 hrs / > 8 h < = 24 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.)
1-23476159- The caller indicates exposure to an herbicide containing the active ingredients 2,4-d, mecoprop, and dicamba. The caller reports he encountered a container of the product that was stored at a high heat in his shed. The package was swollen due to the heat and the reporter opened the package and noted a release of air and a strong odor which he inhaled. This event occurred a day prior to the initial contact with the registrant; he reports he noted a "sore throat" the following morning. The caller was advised of the potential irritant effect of inhalation of the product or fumes from the product and of symptomatic care that could be offered. He was also advised of the threshold at which he might seek medical care. On routine call back the reporter indicted his symptom persisted no more than a day and he did not need to seek medical care. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
