Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4612

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23938265

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.

27-AUG-10

5. 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)

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PMRA Registration No. 27521      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max Perimeter Indoor Insect Control Ready To Use

• Active Ingredient(s)
  • PERMETHRIN

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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. - In Home / Rés. - à l'int. 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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

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)

Application

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?

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.)

1-23938265- The reporter calls to indicate exposure of herself (Sub-form II, #1) and her (age) year son (Sub-form II, #2) to an insecticide containing the active ingredient permethrin. The reporter indicates she had started using the product in her apartment two months prior to the initial contact with the registrant. She was advised to use the product by her landlord for an ant infestation. The caller indicates she and her (age) year old son have developed headaches since the onset of use and she also comments on malaise in her son. She does not describe a discreet exposure incident but rather comments on the smell or aroma following application of the product to the home. She indicates a desire to discontinue use but states her landlord insists she use the product and reused to properly exterminate in the building. The caller was advised that nonspecific symptoms of this nature can be seen in individuals that find an aroma offensive or disagreeable. The caller was advised to discontinue use, clean and ventilate the home. The caller did not respond to follow up attempts.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

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: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• General
  • Symptom - Malaise

4. How long did the symptoms last?

Unknown / Inconnu

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)

Application

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?

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.)

1-23938265- The reporter calls to indicate exposure of herself (Sub-form II, #1) and her (age) year son (Sub-form II, #2) to an insecticide containing the active ingredient permethrin. The reporter indicates she had started using the product in her apartment two months prior to the initial contact with the registrant. She was advised to use the product by her landlord for an ant infestation. The caller indicates she and her fifteen year old son have developed headaches since the onset of use and she also comments on malaise in her son. She does not describe a discreet exposure incident but rather comments on the smell or aroma following application of the product to the home. She indicates a desire to discontinue use but states her landlord insists she use the product and reused to properly exterminate in the building. The caller was advised that nonspecific symptoms of this nature can be seen in individuals that find an aroma offensive or disagreeable. The caller was advised to discontinue use, clean and ventilate the home. The caller did not respond to follow up attempts.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.