Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3190

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-26646599

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.

28-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

22-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. 27801      PMRA Submission No.       EPA Registration No.

Product Name: Killex Lawn Weed Control Concentrate

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)

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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

Préciser le type: lawn

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

• Eye
  • Symptom - Swollen eye

• Skin
  • Symptom - Red skin

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?

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)

Unknown

10. Route(s) of exposure.

Eye

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>3 days <=1 wk / >3 jours <=1 sem

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.)

1-26646599- The reporter indicated he was exposed to an herbicide containing the active ingredient 2,4-4 ( dimethylamine salt), mecoprop-p (propionic acid), dicamba (dimethylamine salt), and dimethylamine. The reporter, an adult male, indicated he had been applying the product to his residential lawn ten days prior to his initial contact with the registrant. He reports he had gotten a drop of the diluted product on his eye lid at that time and did not wash it away but brushed the area with his hand. He noted four days after the exposure his eye lid began to swell and redden. The caller was advised irritation could be seen following ocular exposure that may be mitigated by rinsing the eye. Symptoms that develop days following exposure would be unexpected. He was advised to seek medial attention. On follow up the reporter indicated he had been to a physician and was diagnosed with a stye. He indicated his health matter was unrelated to the exposure. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.