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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3185
2. Registrant Information.
Registrant Reference Number: PROSAR Case #: 1-26479873
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.
Domestic Animal
4. Date registrant was first informed of the incident.
13-JUN-115. Location of incident.
Country: CANADA
Prov / State: QUEBEC
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. 28178 PMRA Submission No. EPA Registration No.
Product Name: Ecosense Path Clear Grass Weed Control Spray
- Active Ingredient(s)
- ACETIC ACID
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 III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Shih Tzu
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
8
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-26479873- The reporter, a pet owner, indicated her animal may have been exposed to an herbicide containing the active ingredients citric acid and acetic acid. The reporter stated she had a field associated with her residence sprayed with the product one week prior to her initial contact with the registrant. She reports her one year old eight pound male Shih Tzu dog had been allowed access to the application area within the past week after the product had been allowed to dry. The pet owner did not describe a discreet exposure incident. The pet was reported to have been vomiting for 3-4 days prior to her initial report. The pet owner was advised of the potential gastrointestinal irritant effect of the product when directly ingested. Given the described use no harm or signs would be expected from contact with the application area. The pet owner was advised to pursue other diagnoses with her veterinarian. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
