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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5770

2. Registrant Information.

Registrant Reference Number: PROSAR Case #: 1-34213749

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.


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. 29694      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Weed B Gon Ready to Use Weed Control

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'

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?


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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
    • Symptom - Staggering
    • Specify - Stumbling
  • General
    • Symptom - Lightheadedness
    • Specify - Light-headed
    • Symptom - Fatigue
    • Specify - Tires quickly

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.



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.)

1-34213749- The reporter indicated he had skin contact with a product containing the active ingredient Iron (Ferric HEDTA). The reporter, an (age) year old male, stated that while he was applying a weed prevention product, some product sprayed on his hands. He washed his hands two times following exposure. Since that time, he has experienced weakness, stumbling, his head feels odd or light-headed, and he tires quickly. He sought medical care with his physician who believed that the symptoms developed from a combination of advanced age, medications for non-specific heart problems, and high heat. The reporter was concerned that the product had been absorbed through his skin and was the cause of the described symptoms. He first contacted the registrant one week after exposure and following medical evaluation. The reporter was advised that skin contact could cause mild irritation, but the active ingredient is not absorbed through the skin and would not be expected to cause the systemic symptoms described. The reporter was further advised that future skin exposure should be treated with 20 minutes of washing to appropriately decontaminate. It was recommended that the reporter continue to work with his physician. No other information is available.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.