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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-3954
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-33863203
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.
02-JUN-135. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
02-JUN-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. 29694 PMRA Submission No. EPA Registration No.
Product Name: Ecosense Weed B Gon Ready to Use Weed Control
- Active Ingredient(s)
- IRON (PRESENT AS FEHEDTA)
7. b) Type of formulation.
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
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
- Skin
- Symptom - Itchy skin
- Symptom - Red skin
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)
Pesticide Spill
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
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>30 min <=2 hrs / >30 min <=2 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.)
1-33863203 - The reporter indicated that his co-worker was exposed to an herbicide containing the active ingredient Ferric HEDTA. The reporter stated that an adult male co-worker was cleaning up a spill at (company name) about 90 minutes prior to initial contact with the registrant and during clean-up he got the product on his hands. Ten minutes after the dermal exposure the patients hands became itchy. The patient washed his hands but the itching was still persistent at the time of the initial call. The reporter was advised that skin exposure may cause transient dermal irritation. On follow-up call, two days later, the reporter indicated that his co-workers symptoms got a little better but the redness had persisted so the patient went to the doctor where he was prescribed an unknown topical medication and told that symptoms should resolve within 3 days. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
