Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4608

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23822017

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-AUG-10

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

12-AUG-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. 22949      PMRA Submission No.       EPA Registration No.

Product Name: Gardel Permethrin Spray

• Active Ingredient(s)
  • PERMETHRIN

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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).

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 - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

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.

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-238220017- The reporter indicates her husband may have been exposed to an insecticide containing the active ingredient permethrin. The caller indicates her husband was using the product seven days preceding initial contact with the registrant. She does not clarify if use was application or in what capacity he was using the product. The caller does not describe a discreet exposure incident. She indicates he has developed a rash on 25% of his body surface area three days following use. The exposed party had gone to his doctor the day of initial contact with the registrant and been given treatment (undisclosed). The caller was guarded about information provided. The caller was informed this is not an expected effect of routine product use. The patient may have an unrecognized hypersensitivity. The caller was advised to follow up with their heath care provider for further treatment advice and assistance in discerning the cause of the rash.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.