Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-1811

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-36819484

Registrant Name (Full Legal Name no abbreviations): The Scotts Company LLC

Address: 14111 Scottslawn Road

City: Marysville

Prov / State: Ohio

Country: USA

Postal Code: 43041

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

20-APR-14

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

6. Date incident was first observed.

20-APR-14

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.

Active(s)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 538-314

Product Name: Snap Pac Weed and Feed 25-0-4

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Guarantee/concentration .723 %
  • DICHLORPROP-P (PRESENT AS DIMETHYLAMINE SALT)
    • Guarantee/concentration .088 %
  • MECOPROP-P (PRESENT AS AMINE SALT)
    • Guarantee/concentration .148 %

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7. b) Type of formulation.

Dust

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.

Other

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 - Lightheadedness

• Gastrointestinal System
  • Symptom - Nausea

• Cardiovascular System
  • Symptom - Stroke

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?

Yes

6. b) For how long?

Unknown

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

1-36819484 -The reporter, the girlfriend of the patient, indicated an exposure to an herbicide that contains the active ingredients 2,4-D, mecoprop-p, and dichlorprop. One hour prior to the initial call, the reporters (age) year old boyfriend had been applying the dust on his lawn. After application he took a shower and during his shower he started feeling lightheaded and nauseous. The reporter was advised that inhalation of the dust may cause transient respiratory irritation. Medical attention was recommended for any severe or persistent symptoms. On follow-up call, two days later, the reporter indicated that her boyfriend had had a stroke and was currently in the hospital. Per the reporter the doctor¿¿¿¿¿¿s think that the patient may have had another stroke a few days prior to any product contact. The doctor¿¿¿¿¿¿s do not believe that the patient¿¿¿¿¿¿s stroke was related to use of the product. No additional information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.