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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-5777

2. Registrant Information.

Registrant Reference Number: 1-34401238

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. 28376      PMRA Submission No.       EPA Registration No.

Product Name: Ecosense Bug B Gon Insecticidal Soap RTU

• Active Ingredient(s)
  • POTASSIUM SALTS OF FATTY ACIDS

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Red skin

• General
  • Symptom - Swelling
  • Symptom - Other
  • Specify - infection

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?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Contact with treated area

What was the activity? Gardening

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.)

1-34401238 - The reporter indicated that she was exposed to an insecticidal product containing the active ingredient potassium salt of fatty acids. The reporter indicated that she recently sprayed her roses with this product and on the day of initial contact with the registrant she accidentally pricked her finger on one of the rose thorns. At the time of the initial call the reporter indicated that the affected finger was swollen and red and the redness was spreading down her finger. The reporter was advised that the described symptoms are not consistent with exposure to the product. Immediate medical attention was recommended for the rapidly progressing symptoms. On follow-up call, seven days later, the reporter indicated that she went to urgent care on the day of initial contact where she was given an antibiotic. The following day, her symptoms were not better, so she went to the ER where they told her that they thought she had an infection and recommended treatment with intravenous antibiotics. Four days later she went back to the ER again and was given a stronger antibiotic. No additional information is available.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.