Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2040

2. Registrant Information.

Registrant Reference Number: PROSAR Case#:1-29791243

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.

16-APR-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

16-APR-12

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)

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PMRA Registration No. 28258      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max Perimeter Indoor Insect Control with Pull N Spray A

• Active Ingredient(s)
  • PERMETHRIN

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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: Unknown / Inconnu

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

• Gastrointestinal System
  • Symptom - Nausea

• Respiratory System
  • Symptom - Respiratory irritation

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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

No

6. a) Was the person hospitalized?

No

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

1-29791243- The reporter indicates he was exposed to n insecticidal product containing the active ingredient permethrin. The reporter stated he had applied the product the night prior to his call at 10 pm. He did not describe application technique or site. He did not describe an exposure route or incident. He reported he had woken up at 3 am with nausea and respiratory irritation. The caller was advised the AI in the concentration seen here is most often addressed as a minor irritant to most body surfaces following know exposures. He was advised irritation was typically fleeting following topical or inhalation exposures once the skin was rinsed and the exposed individual was removed from the area to fresh air. He was advised something else was likely affecting his health. On follow up the reporter indicated he spontaneously resolved within four days and had not seen a doctor. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.