Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2013-3963

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-34074840

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentina Road, Plaza 5, Suite 101

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N 2R7

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

21-JUN-13

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

10-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. 27801      PMRA Submission No.       EPA Registration No. Unknown

Product Name: Killex Lawn Weed Control Concentrate

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)

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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. - 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: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Pain

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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.

Skin

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.)

1-34074840 The report indicated his father- in-law may have been exposed to an herbicide containing the active ingredients 2,4-D, dimethylamine, mecoprop-p, dicamba, and dimethylamine. The reporter stated two weeks prior to the initial report his age year old father-in-law had spilled the concentrated product on his hand. Two days after the exposure her had developed pain in two of the fingers on the hand he had spill the product on. He had gone to the doctor when the discomfort was first noted and been prescribed topical corticosteroid and oral acetaminophen/codeine tablets for pain. The pain had not resolved two weeks later and his prescription had run out. The reporter was advised symptoms of the severity and duration described would not be anticipated following topical exposure to this product. The caller was advised his father should return to the doctor to be reassessed. Follow up was not obtained from the caller. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

Status update: On follow-up call, five days later, the reporter indicated that he had just been to his doctor who had diagnosed shingles in the affected hand. No further information is available.