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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-3840

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-26996708

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

Packaging Failure

4. Date registrant was first informed of the incident.

30-JUL-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

30-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)

PMRA Registration No. 28208      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HOME DEFENSE MAX INDOOR INSECT CONTROL AEROSOL

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • PERMETHRIN
    • PYRETHRINS

7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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 - Irritated eye
  • Respiratory System
    • Symptom - Irritated nose
  • Gastrointestinal System
    • Symptom - Nausea
  • Respiratory System
    • Symptom - Respiratory irritation
  • Eye
    • Symptom - Burning eye

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)

Pesticide Spill

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-26996708- The reporter indicated he was exposed to an insecticide containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide, and permethrin. The reporter indicated the product had leaked out the bottom of the container while being stored in his garage. He did not further describe how the leak had occurred. As he entered the room he had detected the aroma of the product and was concerned about inhalation. He reported he was experiencing at the time of the call a burning sensation in his eyes, nasal irritation, nausea, and respiratory irritation. The reporter was advised of expectations following this avenue of exposure; he was advised of symptomatic care that may be offered at home and the threshold at which he should seek medical attention. The reporter did not respond to follow up attempts. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Can / Cannette

2. Did packaging failure occur during?

Storage

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

1-26996708- The reporter indicated he w exposed to an insecticide containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide, and permethrin. The reporter indicated the product had leaked out the bottom of the container while being stored in his garage. He did not further describe how the leak had occurred. As he entered the room he had detected the aroma of the product and was concerned about inhalation. He reported he was experiencing at the time of the call a burning sensation in his eyes, nasal irritation, nausea, and respiratory irritation. The reporter was advised of expectations following this avenue of exposure; he was advised of symptomatic care that may be offered at home and the threshold at which he should seek medical attention. The reporter did not respond to follow up attempts. No further information is available.

For Registrant use only

5. Provide supplemental information here.