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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5772

2. Registrant Information.

Registrant Reference Number: PROSAR Case#: 1-34225504

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.       PMRA Submission No.       EPA Registration No. 2217-896-239

Product Name: Weed-B-Gon Max Plus Crabgrass Control Ready Spray

• 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)
  • QUINCLORAC

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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Discolouration
  • Specify - big dots
  • Symptom - Rash
  • Symptom - Blister

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.)

1-34225504 - The reporter indicated that he was exposed to an herbicide containing the active ingredients 2,4-D, Dicamba and Quinclorac. The reporter lives in Canada but purchased this product in the United States and brought it across the border. The reporter states that he applied the herbicide to his lawn two weeks prior to initial contact with the registrant. During application he got some of the product on his leg. He showered after the exposure but indicated that he developed 3 black dots on his leg at the contact site and he has now developed a skin rash and blisters on his leg. On the day of initial contact the caller went to his doctor who prescribed cortisone and Benadryl. On follow-up call, three days later, the caller indicated that his symptoms were improving and that it was possible that his symptoms were from contact with poison ivy. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.