Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4562

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-27108341

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.

11-AUG-11

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

29-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. 27208      PMRA Submission No.       EPA Registration No.

Product Name: Bug-B-Gon Max Ant Chinch Bug Eliminator Concentrate

• Active Ingredient(s)
  • CARBARYL

---

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. - In Home / Rés. - à l'int. 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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Bloating

• General
  • Symptom - Malaise

• Gastrointestinal System
  • Symptom - Stomach cramps
  • Symptom - Bloody diarrhea

• General
  • Symptom - Weakness

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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)

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

1-27108341- The reporter indicate his wife may have been exposed to an insecticide containing the active ingredient carbaryl. The reporter indicted he applied the diluted product to his primary residence two weeks prior to his initial contact with the registrant. The reporter indicated one and one half week prior to his initial contact he his wife developed the symptoms of weakness, abdominal cramps, and bloody diarrhea. Her symptoms had persisted until the point of the initial contact with the registrant. The reporter indicated his wife had not been directly exposed to the product but he was concerned that the product may have leaked into their well water subsequently leading to her health difficulties. He further indicated he and his wife had not been in the home where the product was applied for eleven days prior to his initial contact with the registrant. They had been on vacation. He stated she had been to the doctor three times and had blood tests (nonspecific) which were all reported to be within normal limits. The doctors she had visited had told him she had food poisoning. The reporter was advised the time line, mode of exposure, and symptoms are not consistent with the expected profile of the product or active ingredient. The caller was not reached for follow up. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.