Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4564

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-27149923

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.

15-AUG-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

13-AUG-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. 29834      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Weed B Gon Weed Control with Pull N Spray Applicator

• Active Ingredient(s)
  • IRON (PRESENT AS FEHEDTA)

---

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash

• General
  • Symptom - Swelling

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

1-27149923- The reporter indicated her spouse had been exposed to an herbicide containing the active ingredient Iron (Ferric HEDTA). The reporter indicated her husband had been spraying the product three days prior to her initial contact with the registrant. She did not describe a discreet exposure incident but indicated she was concerned he may have gotten the product on his face and arms. She reported he woke the morning after product use and had a swollen face and a rash on his arms and neck. He visited the doctor and was given an oral antihistamine and his symptoms were improving at the point of the initial contact. The caller was advised rash and dermal swelling are not expected symptoms following known exposures she was advised to follow with his doctor to attempt to determine the cause of his hypersensitivity. On follow up the patient was spoken to. He indicated he had been to the doctor three times since he had developed symptoms his rash had spread to his legs and arms, he reported some improvement in his facial swelling. The caller was not reached for further follow up. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.