Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5794

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-41875917

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.

12-SEP-15

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

12-SEP-15

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. 28208      PMRA Submission No.       EPA Registration No.

Product Name: Ortho Home Defense Max Indoor Insect Control Aerosol

• Active Ingredient(s)
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PERMETHRIN
  • PYRETHRINS

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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. - In Home / Rés. - à l'int. 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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Itchy skin

4. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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)

Contact with treated area

What was the activity? Caller's son sat on a chair that had been treated with the product

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.

<=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.)

1-41875917 - The reporter indicated her son was exposed to an insecticidal spray containing the active ingredients pyrethrins, n-octyl bicycloheptene dicarboximide and permethrin. The reporter applied the product to a chair in her home on the morning of initial contact with the registrant. When the reporter contacted the registrant at 10pm Central Standard Time her son had just been sitting in the chair and he had started to itch. The reporter was advised that dermal contact to the wet product may cause transient parasthesia and while rare some sensitive people may develop dermal parasthesia after contacting the dried residue. On follow-up call, two days later, the reporter stated her sons symptoms resolved after about 24 hours. No medical attention was needed. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.