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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4565

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-27178587

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.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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.

PMRA Registration No. 28179      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Path Clear Weed Control Spray with Pull N Spray Applicator

• Active Ingredient(s)
  • ACETIC ACID

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: Female

Age: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Pneumonia

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.

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.)

1-27178587- the reporter indicated she may have been exposed to an herbicide containing the active ingredients acetic acid and citric acid. The reporter indicated she had been applying the product to her lawn every other week during the course of the summer. She indicated a 'few weeks' prior to her initial reports she had been diagnosed and treated for pneumonia. The caller asks if her diagnosis may be related to potential respiratory exposure to the product, but was unable to describe a discreet exposure incident. The reporter was advised of potential transitory respiratory exposure following known inhalation of the product, but that pneumonia would not be expected even following known exposure. She was advised to continue to work with her doctor to determine the cause of her symptoms and the appropriate therapy. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.