Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-0115
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-42555222
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.
Domestic Animal
4. Date registrant was first informed of the incident.
25-NOV-15
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
25-NOV-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)
PMRA Registration No. 2009025
PMRA Submission No.
EPA Registration No.
Product Name: Turf Builder Lawn Fertilizer 10-0-0 with Weed Prevent
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
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 III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Goldendoodle
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1.5
7. Weight (provide a range if necessary )
75
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
12. How long did the symptoms last?
<=30 min / <=30 min
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-42555222 - The reporter, a pet owner, indicated that his dog was exposed to a weed preventer containing the active ingredient corn gluten meal. The reporter indicated that his 75 pound, 1.5-year-old, female Goldendoodle ingested an unknown amount of the product off of the floor about 4 hours prior to initial contact with the registrant. After the exposure the dog vomited two times. The reporter was advised that the product has a wide margin of safety but with ingestion transient gastrointestinal irritation is possible. On follow-up call, five days later, the reporter indicated that the dog only vomited the two times and then symptoms resolved. No medical attention was needed. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here