Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4110

2. Registrant Information.

Registrant Reference Number: PROSAR case # 1-23919833

Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC

Address: 14111 Scottslawn Road

City: Marysville

Prov / State: Ohio

Country: USA

Postal Code: 43041

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

30-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

30-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 228-424-239

Product Name: Weed-B-Gon Max Concentrate 32 fl oz

• Active Ingredient(s)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration 1.35 %
  • MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)
    • Guarantee/concentration 13.72 %
  • TRICLOPYR TRIETHYLAMINE SALT
    • Guarantee/concentration 1.56 %

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7. b) Type of formulation.

Liquid

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 III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify unknown unspecified by reporter

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-23919833- The reporter, a pet owner, indicated her animal had been exposed to an herbicide containing the active ingredients MCPA, Triclopyr Dicamba. The caller indicates at the point of contact with the registrant that she was at her veterinarian¿s office and her dog had just died. She did not specify age, size or breed of the dog. She did not indicate if any signs were seen leading up to the animals death, or if treatment was provided. The caller indicated her neighbor had used the product preceding the animal¿s death. The use was not described and no discreet exposure incident was described. No further information is available.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Sudden death is inconsistent with most exposures seen in domestic animals following use/application. The product, in most circumstances, is an mild irritant to body surfaces it may come in contact with.