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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-2586
2. Registrant Information.
Registrant Reference Number: PROSAR Case#:1-32991687
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.
11-MAR-135. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
11-MAR-13Product 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. 28379 PMRA Submission No. EPA Registration No.
Product Name: Ecosense Bug B Gon Insecticide RTU
- Active Ingredient(s)
- PYRETHRINS
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.
Other
2. Demographic information of data subject
Sex: Male
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Respiratory System
- Symptom - Nasal congestion
- Symptom - Other
- Specify - nasal swelling
- Nervous and Muscular Systems
- Symptom - Numbness
- Eye
- Symptom - Blurred vision
- Symptom - Irritated eye
4. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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)
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.)
1-32991687 - The reporter indicated that her husband was exposed to an insecticidal product containing the active ingredients pyrethrins. Per the reporter her husband applied approximately 10 squirts of the product on some bugs in the lower area of the home approximately 2.5 hours prior to initial contact with the registrant. During product application there was a fan blowing in the area and although no dermal, ocular or product inhalation was noted by the patient at the time of product application the reporter indicates that the fan may have blown mist back at her husband s face. About one hour after application her husband began complaining of nasal swelling and congestion, numb lips, eye irritation and blurred vision. At the time of initial contact the patient had already irrigated his eyes for a period of 10 minutes and had moved away from the fumes. The reporter was advised that the product may potentially cause transient irritation by all routes when there is direct contact to the wet product or inhalation of the product. Medical attention was recommended for any persistent or worsening symptoms. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
