Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-5741

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-38699804

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road, Plaza 2, Suite 300

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N1V8

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

Human

4. Date registrant was first informed of the incident.

10-OCT-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

10-OCT-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. Unknown

Product Name: Killex concentrate (unspecified)

• 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)
  • MECOPROP-P (PRESENT AS AMINE SALT)

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

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

• Skin
  • Symptom - Irritated skin

• Nervous and Muscular Systems
  • Symptom - Muscle cramps
  • Specify - cramping

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

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.)

1-38699804 - The reporter, a home owner, indicated that he was exposed to an herbicide containing the active ingredients 2,4-D, mecoprop-p and dicamba. The reporter no longer had the product packaging and could not provide the product barcode number or registration number. From memory the reporter provided the partial name of Killex Concentrate. Just prior to his inital call the reporter had discarded the product in a garbage bag and as he was carrying the bat it leaked out onto his leg and shoe. He washed after the exposure but at the time of the initial call the affected skin was burning and his foot was cramping. The reporter was advised that dermal contact may cause short-term irritation. On follow-up call, three days later, the reporter indicated that the symptoms resolved in 3 days. No medical attention was needed. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.