Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5219

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23887936

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.

23-AUG-10

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

23-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)

PMRA Registration No. 28178      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Path Clear Weed Control Spray with Quick Connect Sprayer

  • Active Ingredient(s)
    • ACETIC ACID

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

3. List all symptoms, using the selections below.

System

  • Skin
    • Symptom - Edema
    • Symptom - Erythema
    • Symptom - Tingling skin
    • Symptom - Discolouration
    • Specify - blotchy skin

4. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 h

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Contact with treated area

Amount of time between application and contact 3

Day(s) / Jour(s)

What was the activity? Pulling weeds

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 <=2 hrs / >30 min <=2 h

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.)

1-23887936- The reporter, a parent, indicates exposure of his child to an herbicide containing the active ingredient acetic acid. The reporter indicates he applied the product three days prior to the initial contact with the registrant. He did not specify any details regarding the application. The caller reported his (age) daughter had gone out in to the yard to pull weeds one hour prior to the initial contact with the registrant. She now had developed the symptoms of dermal swelling, erythema, tingling and ¿¿¿blotchy skin? on the hand used to pick the weeds. The caller was advised of the mild irritant effect on the skin contact with wetted product may have. Symptoms of the magnitude described would not be expected following dermal contact with application areas three days following application. The caller was advised to see a doctor if the symptoms worsen of persist. On routine call back the reporter indicates his daughter took an antihistamine and had resolved within four hours of the exposure. No further information is available

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.