Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0822

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24798979

Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC

Address: 14111 Scottslawn Road

City: Marysville

Prov / State: Ohio

Country: USA

Postal Code: 43041

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

24-NOV-10

5. Location of incident.

Country: UNITED STATES

Prov / State: OKLAHOMA

6. Date incident was first observed.

24-NOV-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 239-2665

Product Name: Weed-B-Gon LawnGuard Formula Concentrate

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration 3.05 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration 1.3 %
  • MECOPROP (PRESENT AS AMINE SALT)
    • Guarantee/concentration 5.3 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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: Male

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Unresponsive
  • Specify - stupor

• Eye
  • Symptom - Tearing

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Non-occupational

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

Poisoning from ingestion of the pesticide

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.

Oral

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-24798979- The reporter indicates exposure of a friend to an herbicide containing the active ingredients Mecoprop-p, 2,4-D, and Dicamba. The reporter indicated his (age) male friend had, in an apparent self harm attempt, ingested an unknown amount of the product within twenty minutes of his initial contact with the registrant. The exposed individual was observed on the ground and described as quite groggy at the point of the initial contact. The caller was advised of the expected irritant effect of the product, but that significant harm would not be expected. He was advised to seek prompt medical attention due to the nature of the call, the symptoms observed, and because many self harm attempts may involve co-ingestions. On routine follow up two days later the reporter indicated his friend was in the hospital. He was reported to have been on a respirator? for at least 24 hours but was now alert and awake. According to the friend the patient was being transferred to a mental institution?. The reporter also indicated the patient had been taking Klonipin the night prior to the report. The reporter gave contact information for the (name) where the patient was being treated for further follow up. Following several attempts follow up was obtained from the (name) nurse attending to the patient at the time of transfer to a long term care facility. It was reported the patient was physically well but tearful and lethargic at transfer. It was revealed that a drug screen at presentation on 11/24/10 revealed benzodiazepines, amphetamine, methamphetamine, and marijuana in the patients system. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.