Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3399

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-33828376

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.

29-MAY-13

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

27-MAY-13

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.       PMRA Submission No.       EPA Registration No. 239-2682

Product Name: Weed-B-Gon Max

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration .12 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Guarantee/concentration .05 %
  • MECOPROP-P (PRESENT AS AMINE SALT)
    • Guarantee/concentration .22 %

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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 / 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.

Other

2. Demographic information of data subject

Sex: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - Joint weakness

• General
  • Symptom - Weakness

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?

Unknown

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)

Chemical resistant gloves

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.)

1-33828376 - The reporter indicated that his wife was exposed to an herbicide containing the active ingredients 2,4-D, Mecoprop-p and Dicamba. The reporter states that his (age) year old wife applied the product outside their home two days prior to initial contact with the registrant. No exposure through skin contact, inhalation or ingestion was noted at the time of application and the patient did wear gloves while applying the product but four hours after product application the reporters wife suffered from vomiting. The reporter indicates that his wife has since been admitted to the local hospital intensive care unit for severe diarrhea, vomiting and weakness in her joints. The length of the hospital stay and the treatment that was provided is unknown. The reporter was advised that the product has a wide margin of safety; with routine use and no known ingestion of the product severe vomiting and diarrhea would not be expected. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.