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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6004

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-24508235

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-OCT-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

21-OCT-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. 22027      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max No-Pest Insecticidal Strip

  • Active Ingredient(s)
    • DICHLORVOS PLUS RELATED ACTIVE COMPOUNDS

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?

No

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • General
    • Symptom - Fatigue

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

Amount of time between application and contact .5

Day(s) / Jour(s)

What was the activity? Application site is a residence/dwelling. Re-entry into the home.

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.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

1-24508235- The reporter indicates potential exposure of both herself and a tenant to an insecticide containing the active ingredient dichlorvos. The caller reports she had her home fumigated two days prior to the initial contact with the registrant. The home was treated by a commercial pest control operator. It was stated the PCO used an unknown ¿¿¿bed bug product? and cut up the registrant¿¿¿s product into strips and placed the cut up pieces among clothing in the household. The registrant¿¿¿s product is an insecticidal strip labeled for use in unoccupied areas. The product is not labeled for use in homes except in attics, crawl spaces and sheds occupied for less than four hours daily. The caller indicated an aroma could be detected on re-entry. The day after re-entry the reporter (Sub-form II, #1) noted dizziness and shortness of breath, the reporter stated her tenant (Sub-form II, #2) indicated fatigue. The reporter was advised to minimize contact by ventilating and removing the product from the household. The caller was advised the symptoms seen should be self-limiting once fresh air is assured. As described, respiratory irritation would be the limit of expected symptoms. The caller was advised to seek medical attention is the symptoms persisted or worsened. The reported did not respond to follow up attempts. No further information is available.

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: Female

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

3. List all symptoms, using the selections below.

System

  • Nervous and Muscular Systems
    • Symptom - Dizziness
  • Respiratory System
    • Symptom - Shortness of breath

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

Amount of time between application and contact .5

Day(s) / Jour(s)

What was the activity? Application site is a residence/dwelling. Re-entry into the home.

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.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

1-24508235- The reporter indicates potential exposure of both herself and a tenant to an insecticide containing the active ingredient dichlorvos. The caller reports she had her home fumigated two days prior to the initial contact with the registrant. The home was treated by a commercial pest control operator. It was stated the PCO used an unknown ¿¿¿bed bug product? and cut up the registrant¿¿¿s product into strips and placed the cut up pieces among clothing in the household. The registrant¿¿¿s product is an insecticidal strip labeled for use in unoccupied areas. The product is not labeled for use in homes except in attics, crawl spaces and sheds occupied for less than four hours daily. The caller indicated an aroma could be detected on re-entry. The day after re-entry the reporter (Sub-form II, #1) noted dizziness and shortness of breath, the reporter stated her tenant (Sub-form II, #2) indicated fatigue. The reporter was advised to minimize contact by ventilating and removing the product from the household. The caller was advised the symptoms seen should be self-limiting once fresh air is assured. As described, respiratory irritation would be the limit of expected symptoms. The caller was advised to seek medical attention is the symptoms persisted or worsened. The reported did not respond to follow up attempts. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.