Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-6244

2. Registrant Information.

Registrant Reference Number: PROSAR case #: 1-42092124

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.

05-OCT-15

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

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.

Active(s)

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PMRA Registration No. 22027      PMRA Submission No.       EPA Registration No.

Product Name: Ortho Home Defense Max No-Pest Insecticidal Strip

• Active Ingredient(s)
  • DICHLORVOS PLUS RELATED ACTIVE COMPOUNDS

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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).

The reporter used the product in a room in his home. Per package labeling the product is meant to be used in unoccupied areas eg. garages, attics, sheds and cottages (when not in use).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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

• Respiratory System
  • Symptom - Respiratory congestion

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Unknown

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

Contact with treated area

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.

Respiratory

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.)

1-42092124 The reporter indicated that he had been exposed to an insecticide containing the active ingredient dichlorvos. The reporter used the strip in a room in his home two months prior to initial contact with the registrant. Four days prior to initial contact with the registrant the reporter became congested; as if he had a cold. The reporter was advised that there are numerous possible causes for the described symptoms and medical attention was recommended to determine an underlying cause for his symptoms. Per package labeling the product is only meant to be used in unoccupied areas where there is unlikely to be continuous occupation for more than 4 hours. No further information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.