Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-4006

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-44529004

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.

19-JUN-16

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

19-JUN-16

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. 27521      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HOME DEFENSE MAX PERIMETER & INDOOR INSECT CONTROL READY-TO-USE

• Active Ingredient(s)
  • PERMETHRIN

---

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. - 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 III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Golden Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

95

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Vomiting

• Renal System
  • Symptom - Inappropriate urination

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-44529004 - The reporter, a pet owner, indicates her dog may have been exposed to a pesticide containing the active ingredient permethrin. The reporter stated her 95-pound, 11-year-old, male, Golden Retriever dog had access to a lawn four hours after it had been treated with the product on the morning of the day of initial contact with the registrant. The same day the dog developed vomiting, lethargy and inappropriate urination. The reporter was advised that small ingestions of the product might cause mild gastrointestinal irritation such as vomiting, but not the rest of the reported symptoms. The reporter was advised to get medical attention for the dog. No follow-up was attempted. 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