Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-1536

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-32558361

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.

25-JAN-13

5. Location of incident.

Country: CANADA

Prov / State: UNKNOWN

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.

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/Spray Appli

• 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: Res. - In Home / Rés. - à l'int. 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

• Skin
  • Symptom - Rash

• Respiratory System
  • Symptom - Difficulty Breathing
  • Specify - Breathing problems

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?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

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.

Skin

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.)

1-32558361 - The reporter, a homeowner indicated that both he and his girlfriend were exposed to a pesticide containing the active ingredient permethrin and to another registrant pesticide for which the reporter was unable to provide sufficient information to identify the active ingredients. The reporter indicated that two and a half months prior to initial contact with the registrant he applied both products in his home and since that time he reapplied both products two more times. The reporter indicated that both he and his girlfriend have had rashes and breathing problems. Also, his girlfriend has been feeling dizzy and fell down one time. The reporter has been to a clinic several times but they cannot determine the cause of his symptoms. The reporter was advised that the products may cause transient skin and respiratory irritation but the described persistent symptoms are not consistent with product exposure. The caller was further advised to continue working with his doctor for appropriate diagnosis and treatment. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Skin
  • Symptom - Rash

• Respiratory System
  • Symptom - Difficulty Breathing
  • Specify - Breathing problems

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - fell down

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

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.

Skin

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.)

1-32558361 - The reporter, a homeowner indicated that both he and his girlfriend were exposed to a pesticide containing the active ingredient permethrin and to another registrant pesticide for which the reporter was unable to provide sufficient information to identify the active ingredients. The reporter indicated that two and a half months prior to initial contact with the registrant he applied both products in his home and since that time he reapplied both products two more times. The reporter indicated that both he and his girlfriend have had rashes and breathing problems. Also, his girlfriend has been feeling dizzy and fell down one time. The reporter has been to a clinic several times but they cannot determine the cause of his symptoms. The reporter was advised that the products may cause transient skin and respiratory irritation but the described persistent symptoms are not consistent with product exposure. The caller was further advised to continue working with his doctor for appropriate diagnosis and treatment. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.