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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5776

2. Registrant Information.

Registrant Reference Number: 1-34474933

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: QUEBEC

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. 27521      PMRA Submission No.       EPA Registration No.

Product Name: Home Defense Max Perimeter/Indoor Insect Control RTU

• Active Ingredient(s)
  • PERMETHRIN

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Chemical taste in mouth
  • Specify - Unpleasant taste

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)

Pesticide Spill

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.

<=30 min / <=30 min

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.)

1-34474933 - The reporter indicated that he was exposed to an insecticidal product containing the active ingredient permethrin. The reporter indicated that just prior to initial contact with the registrant the product accidentally spilled on his floor. The reporter cleaned up the spill with his bare hands and may have inhaled some of the product fumes during cleaning. At the time of initial contact, the reporter was complaining of a bad taste in his mouth. The reporter was advised that inhalation and dermal exposure may cause transient irritation. Fresh air and a thorough washing of any contaminated skin was recommended. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.