Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3400

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-33641432

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.

13-MAY-13

5. Location of incident.

Country: UNITED STATES

Prov / State: MICHIGAN

6. Date incident was first observed.

10-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 RTU

• 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.

Data Subject

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash
  • Symptom - Itchy skin

• Renal System
  • Symptom - Urine discoloration

• General
  • Symptom - Cancer

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)

Long-sleeve shirt

Long pants

10. Route(s) of exposure.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

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.)

1-33641432 - The reporter indicated that she was exposed to an herbicide containing the active ingredients 2,4-D, Mecoprop-p and Dicamba. The reporter states she applied the product outside her home two times the most recent application was five 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 reporter did wear long sleeves and long pants while applying the product but two days after product application the reporter developed a rash that affected her arms, back, stomach and legs. The reporter had been taking Benadryl at higher than the recommended doses and applying hydrocortisone cream but the rash still persisted at the time of the initial call. The reporter also indicated that she just recently went to the doctor because her urine had turned orange and the doctor had performed a urinalysis and blood work. The reporter was advised that skin exposure may cause transient irritation and that there are several possible causes for a rash. The reporter was further advised that discolored urine is not consistent with exposure to the product. The reporter was advised to seek medical attention to find an underlying cause for her symptoms and appropriate treatment. The reporter responded that she would be returning to the doctor that same day. On follow-up call, three days later, the reporter indicated that she had been admitted to the hospital two days after initial contact and diagnosed with cancer. The reporter indicated that she did not feel her symptoms were from exposure to this product. No further information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.