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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1169

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-25284027

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.

5. Location of incident.

Country: UNITED STATES

Prov / State: COLORADO

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.

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Ortho Weed B Gon Max

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration .12 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration .05 %
  • MECOPROP-P (PRESENT AS AMINE SALT)
    • Guarantee/concentration .22 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Cracked skin
  • Symptom - Other
  • Specify - skin infection/celluitis
  • Symptom - Dry skin
  • Symptom - Blister
  • Symptom - Rash

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?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Unknown

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.

Skin

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.)

1-25284027- The reporter indicates she has been exposed to an herbicide containing the active ingredients mecoprop-p, 2,4-D, and dicamba. The reporter posted a note on the registrant¿¿¿s website indicating exposure to the product during use six months prior to her initial report. She indicates she had gotten the product on her hands and feet. She described decontamination following exposure by washing/rinsing the affected areas. The reporter indicated cracks on the skin of her thumbs, blisters between her toes, and a rash that ¿¿¿won¿¿¿t go away?. The reporter indicates she was hospitalized ¿¿¿over Christmas? due to cellulitis in her left foot secondary to persistent cracks in that foot. Attempts were made to contact the reporter to clarify details of her history and assess her current condition. She did not respond to those attempts. Transient mild topical irritation is the extent of the effect that might bee seen following topical exposure to this product. The symptoms given appear inconsistent with the exposure described. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.