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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4203

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-31540161

Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC

Address: 14111 Scottslawn Road

City: Marysville

Prov / State: Ohio

Country: USA

Postal Code: 43041

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

15-SEP-12

5. Location of incident.

Country: UNITED STATES

Prov / State: MASSACHUSETTS

6. Date incident was first observed.

13-SEP-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 228-424-239

Product Name: Weed-B-Gon Max Ready Spray

  • Active Ingredient(s)
    • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
      • Guarantee/concentration 1.35 %
    • MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)
      • Guarantee/concentration 13.72 %
    • TRICLOPYR TRIETHYLAMINE SALT
      • Guarantee/concentration 1.56 %

7. b) Type of formulation.

Liquid

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 / Rs - 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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Cardiovascular System
    • Symptom - Chest pain
    • Specify - Chest pain
  • Respiratory System
    • Symptom - Other
    • Specify - Pulmonary blood clots
  • General
    • Symptom - Cancer
    • Specify - Multiple myeloma
  • Respiratory System
    • Symptom - Pneumonia
    • Specify - possible 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?

Yes

6. b) For how long?

3

Day(s) / Jour(s)

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.

>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.)

1-31540161 - The reporter, the patients spouse, indicated that her husband was exposed to an herbicide containing the active ingredient MCPA, Triclopyr and Dicamba. The husband, an adult male who had previously been diagnosed with COPD, applied the product in his yard without wearing a mask two days prior to initial contact with the registrant. The following day the patient suffered from right sided chest pain and he went to the doctor that day where he was initially diagnosed with possible pneumonia. Caller was advised that the product may cause transient respiratory irritation and people with underlying respiratory disease may develop more severe symptoms but pneumonia would not be expected from product exposure. On follow-up two days later the reporter indicated that her husband was hospitalized on the day of initial contact and stayed in the hospital for three days. He was diagnosed with multiple myeloma and pulmonary blood clots the doctor did not think that his disease was from exposure to the product. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.