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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4610
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23936400
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.
Domestic Animal
4. Date registrant was first informed of the incident.
27-AUG-105. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
Unknown
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. PMRA Submission No. EPA Registration No. 2008066
Product Name: Turf Builder Plus 2 Lawn Fertilizer 28-1-4 Weed Control with Mecopro
- Active Ingredient(s)
- 2,4-D (PRESENT AS ACID)
- MECOPROP P-ISOMER (PRESENT AS ACID)
- SULPHUR
7. b) Type of formulation.
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
mixed breed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
30
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Lethargy
- Gastrointestinal System
- Symptom - Anorexia
- Symptom - Diarrhea
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
Unknown
15. Outcome of the incident
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-23936400- The reporter, a pet owner, indicates his animal may have been exposed to an herbicide containing Sulfur, 2,4-D, and Mecoprop-P. The reporter stated he applied the product to the lawn of his residence one week prior to the initial contact with the registrant. His four year thirty pound mixed breed dog had access to the application area. It is unclear when the animal was allowed to reenter the application area. According to the owner and no exposure was observed. The animal developed lethargy, anorexia, and diarrhea three days after application. The animal was at the veterinarian at the time of the initial contact with the registrant. The caller was informed that the signs seen would not be expected following application of the product per label instructions. The caller was informed of potential gastrointestinal irritant effects ingestion of the product and symptomatic care that may be offered. On routine follow up the reporter informed the registrant that the animal was placed on intravenous fluids for an indeterminate time frame at the veterinarian¿s office. The animal did fully resolve but its signs persisted for one week. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
