Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3187

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-26549330

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.

18-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

18-JUN-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)

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PMRA Registration No. 28179      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Path Clear Weed Control Spray with Pull N Spray Applicator

• Active Ingredient(s)
  • ACETIC ACID

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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.

Other

2. Demographic information of data subject

Sex: Male

Age: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• Eye
  • Symptom - Irritated eye
  • Symptom - Red eye
  • Symptom - Swollen eye

4. How long did the symptoms last?

Unknown / Inconnu

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

No

6. a) Was the person hospitalized?

No

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? pulling weeds

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.

Eye

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

1-26549330- The reporter, a parent, describes possible exposure of her child to an herbicide containing the active ingredients acetic acid and citric acid. The reporter indicates eh had applied the product to weeds around her residence five days prior to her initial contact with the registrant. She reports her (age) child was observed pulling those same weeds within thirty minutes of her initial contact with the registrant. She indicated the child had rubbed his eyes without first washing his hands. She had at the time of the call noted eye redness, eye irritation and eye swelling. The caller was advised of the potential irritant effect of direct ocular exposure. She was advised of appropriate care and the threshold at which to seek medical attention. On follow up the parent indicated she had rinsed the child¿s eyes and the symptoms spontaneously resolved. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.