Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3958

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-33898510

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.

05-JUN-13

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

04-JUN-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. 30144      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Weed B Gon Weed Control Concentrate

• Active Ingredient(s)
  • IRON (PRESENT AS FEHEDTA)

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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 N Spray

• Active Ingredient(s)
  • PERMETHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

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.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Headache

• Respiratory System
  • Symptom - Coughing
  • Symptom - Respiratory pain

• General
  • Symptom - Malaise

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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.

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.)

1-33898510 - The reporter indicated that he was exposed to an herbicide containing the active ingredient Ferric HEDTA and to an insecticide containing the active ingredient permethrin. The reporter indicated that one day prior to initial contact with the registrant he mixed an insecticide and a pesticide together along with some grass seed and soon after mixing he developed a headache and a cough. On the day of initial contact the reporter indicated that he had taken pain medication so his headache was not a concern but the reporter still had a cough and was also complaining of lung pain and he stated that he felt like he was getting a cold. The reporter did indicate that he had a cough before he mixed these products but the cough got worse after his exposure. The reporter was advised that inhalation may cause transient respiratory irritation but symptoms should resolve soon after the patient is moved to fresh air. On follow-up call, two days later, the reporter indicated that his lung pain was only present on the day of initial contact and was no longer a concern. The reporter did indicate that he still had a cough and a headache but pain medications were helping control his headache. It was recommended that he seek medical attention for any severe or persistent symptoms. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.