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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4607
2. Registrant Information.
Registrant Reference Number: PROSAR Case# 1-23708416
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.
05-AUG-105. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
05-AUG-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: KILLEX READY-TO-USE HERBICIDE QUICK CONNECT SPRAY
- 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)
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
- Skin
- Symptom - Irritated skin
- Symptom - Peeling skin
- General
- Symptom - Chemical taste in mouth
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
Unknown
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? wind blew a fine mist of the product onto his face
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 / <=30 min
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.)
1-23708416- The reporter calls to indicate exposure to an herbicide containing the active ingredients 2,4-d, mecoprop-p, and dicamba. The caller indicated the wind blew a fine mist of the product onto his face within 30 minutes of the initial contact with the registrant. The caller did not clarify whether he was applying the product or in what capacity he was exposed. The caller indicates he immediately rinsed his skin for 15-20 minutes but was experiencing dermal irritation at the time of the call. He also reported he could taste the product at the time of the call. The caller was informed of the potential irritant effect of the product but low order of systemic toxicity. He was advised of proper decontamination and symptomatic care. He was advised of the threshold at which he should seek medical care. On routine call back the caller indicated the irritation persisted for four days during which time he noted some peeling skin. He stated he had resolved without need to see a doctor. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
