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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4697

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-31493117

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. 25878      PMRA Submission No.       EPA Registration No.

Product Name: Bug-B-Gon Max Hornet and Wasp Eliminator Spray (Ortho)

• Active Ingredient(s)
  • RESMETHRIN

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: Male

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Chemical taste in mouth
  • Specify - Unpleasant taste

• Gastrointestinal System
  • Symptom - Tingling in mouth
  • Symptom - Nausea

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.)

1-31493117 - The reporter indicated that he was exposed to an insecticidal product containing the active ingredient resmethrin. The reporter, a age year-old, male sprayed the product two weeks prior to initial contact with the registrant. While spraying the product the reporter indicated that he held his breath and then ran away about 20 meters before breathing again. Shortly after spraying the product he developed an unpleasant taste in his mouth and tingling sensation which has persisted up until time of initial contact. Caller was advised that contact with the wet product may cause transient parasthesia but symptoms typically resolve within 24 hours after exposure. Prolonged symptoms are not consistent with product exposure and medical evaluation was recommended. On follow-up two days later the reporter indicated that his symptoms were still present and he had seen a doctor who agreed that prolonged symptoms would not be expected from the product. On follow-up five days after initial contact the reporter indicated that his symptoms were still persisting and he also felt nauseous. Caller was advised that his symptoms are not consistent with product exposure and he was encouraged to continue working with his doctor to determine an underlying cause for his symptoms and appropriate treatment. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.