Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3839

2. Registrant Information.

Registrant Reference Number: PROSAR Case #:1-26912017

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.

27-JUL-11

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

17-JUL-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-ISOMER (PRESENT AS 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.

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

• Skin
  • Symptom - Irritated skin
  • 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?

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.)

1-26912017- the reporter indicates he was exposed to an herbicide containing the active ingredients 2, 4-D (dimethylamine salt), mecoprop-p, dicamba, and dimethylamine. The reporter indicated he applied the diluted product to his residential lawn four days prior to his initial report. He reported wearing short pants, shoes and socks during application. He reported a short while after (nonspecific time frame) he felt a little dermal irritation but did not pay much attention to the sensation. The day following application he noted more significant irritation on his skin on his legs and started to develop a rash from the point where his shorts and socks did not cover his skin. The reporter was advised rash or hypersensitivity response is not a expectation following dermal exposure to the active ingredients or the formulation. He was advised of OTC care he may use to alleviate his symptoms and the threshold at which he may seek medical care. The caller could not be reached for follow up. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.