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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5221

2. Registrant Information.

Registrant Reference Number: PROSAR Case#1-23838218

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.

18-AUG-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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. 27521      PMRA Submission No.       EPA Registration No.

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

  • Active Ingredient(s)
    • PERMETHRIN

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

  • Respiratory System
    • Symptom - Difficulty Breathing
  • General
    • Symptom - Pain
  • Nervous and Muscular Systems
    • Symptom - Numbness

4. How long did the symptoms last?

Unknown / Inconnu

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

What was the activity? dwelling in primary residence

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.

Unknown

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.)

1-23838218- The reporter calls to indicate exposure to an insecticide containing the active ingredient permethrin. The caller states her landlord applied the product ¿¿¿heavily? to her home one month prior to her initial contact with the registrant. The caller describes the development of ¿¿¿breathing problems?, pain in her arms, chest and left knee, and numbness in her fingers several days following application of the product. The caller does not describe a discreet exposure but indicates the smell of the product is strong in her home. The caller was advised aromas of the product can elicit nonspecific symptoms of nausea, headache, and respiratory irritation when encountered by sensitive individuals. No specific harm would be expected from encountering aromas. The caller was advised to ventilate the application area, clean the application area and consult a doctor. On routine call back the registrant was informed the reporter still experience pain in her arms and her index finger was numb one week following the initial call. All other symptoms had resolved. She had not seen a doctor. She was advised to consult a doctor as both the symptoms and persistence were inconsistent with the possible exposure described. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.