Print | Need Larger Text?

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5293

2. Registrant Information.

Registrant Reference Number: 1-34693436

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.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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.

PMRA Registration No. 29834      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Weed B Gon Weed Control with Pull N Spray

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

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Dry skin
  • Symptom - Red skin
  • Symptom - Itchy 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)

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.

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.)

1-34693436 - The reporter, a home owner, indicated that she was exposed to an herbicide containing the active ingredient iron EDTA. The reporter an (age) year old female indicated that she had applied the product outside her home about 1.5 to 2 weeks prior to initial contact with the registrant and during product application the reporter thinks some overspray got on her arms, the side of her body and on her legs. At the time of the initial call the reporter indicated that some areas of her skin are red, dry and itchy. The reporter was advised that a rash may be an indication of an allergic reaction to this or some other product. Medical attention was recommended for any severe or persistent symptoms. On follow-up call, six days later, the reporter indicated that she went to her doctor who recommended that she use a couple of topical creams and prescribed prednisone. The reporter indicated that her symptoms are improving. No further information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.