Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-5819

2. Registrant Information.

Registrant Reference Number: ProPharma Group case 1-45143752

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.

07-AUG-16

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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. 30472      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HOME DEFENSE MAX PERIMETER & INDOOR INSECT CONTROL

• Active Ingredient(s)
  • PERMETHRIN

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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. - 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

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

10

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

• Cardiovascular System
  • Symptom - Abnormally high blood pressure

• Blood
  • Symptom - Other
  • Specify - Hyperproteinemia

• Nervous and Muscular Systems
  • Symptom - Shaking

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

1-45143752 - The reporter, a pet owner, indicates her dog was exposed to a pesticide containing the active ingredient permethrin. The reporter stated she applied the diluted product to her lawn two weeks before, then again two days before initial contact with the registrant. The reporter indicated her 10-year-old, 10-pound, female dog of unknown breed may have had contact with the area at some time, but the reporter did not witness any exposure. For the last two weeks before initial contact with the registrant, the dog has had high blood pressure and high protein in her blood which is not controllable with medication. The dog has also been shaking during the night. The reporter was advised that ingestion of the product may cause stomach upset, but unlikely to cause the symptoms described, and she should continue to work with her veterinarian. No follow-up was attempted. No additional information is available.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here