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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-1462

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-29626913

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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. 2009025      PMRA Submission No.       EPA Registration No.

Product Name: Scotts Turf Builder Lawn Fertilizer 10-0-0

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

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?


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.


  • Eye
    • Symptom - Swollen eye
    • Symptom - Discharge eye
    • Symptom - Other
    • Specify - pimples on eyelid/eyelid infection
    • Symptom - Irritated eye

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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)


10. Route(s) of exposure.


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.)

1-29626913- The reporter indicates he was exposed to an herbicidal product containing the active ingredient Corn Gluten Meal. The reporter indicated he was applying the product five days prior at his residence when the wind blew the product in his eye. He reported he had rinsed his eye extensively after the exposure but the ocular irritation had ensued since the exposure. He had noted swelling and pimples on his eyelid at the point of his initial report. He indicated he was going to the doctor and had wanted literature to provide the physician as he had an appointment pending. On follow up four days later the patient was not reached but one of his coworkers was reached. The caller may have placed his initial report from his place of business. The coworker had indicated the patient had surgery on his eyelid the day of his initial report to drain his eyelid which was found to be infected. He indicated the patient was recovering. No further information was available. The symptoms described are inconsistent with the expectations of the active ingredient or the finished product.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.