Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-2625
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-26104902
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.
10-MAY-11
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
09-MAY-11
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. 29694
PMRA Submission No.
EPA Registration No.
Product Name: Ecosense Weed B Gon RTU Weed Control
- Active Ingredient(s)
- IRON (PRESENT AS FEHEDTA)
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: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Skin
- Symptom - Irritated skin
- Symptom - Red skin
- Symptom - Pain
- Specify - stinging
- Symptom - Irritated skin
- Specify - dermal irritation
4. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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)
Application
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
None
10. Route(s) of exposure.
Skin
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>2 hrs <=8 hrs / > 2 h < = 8 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.)
1-26104902- The caller reports exposure to an herbicide that contains the active ingredient Iron (Ferric HEDTA). The caller reports she was applying the product to her residential lawn the day prior to her initial contact with the registrant and may have gotten the product on her legs. The caller reports washing her legs after application. The caller reports icing her leg due to a pre-existing injury and being in a spa for 40 minutes due to the same injury. The caller reports 2-3 hours later she indicates stinging and redness on the site where the ice pack was placed. The caller was advised of the potential for dermal irritation following topical exposure, was advised of symptomatic care and the threshold at which she should seek medical care. On follow up the reporter indicated the symptom persisted for 3 days and spontaneously resolved.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.