Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-2865
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 1-52450722
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.
19-MAY-18
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)
PMRA Registration No. 29695
PMRA Submission No.
EPA Registration No.
Product Name: SCOTTS ECOSENSE WEED-B-GON RTU WEED CONTROL WITH QUICK CO
- Active Ingredient(s)
- IRON (PRESENT AS FEHEDTA)
PMRA Registration No. 32129
PMRA Submission No.
EPA Registration No. Unknown
Product Name: ORTHO ANT B GON MAX ANT KILLER FOAM
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- PERMETHRIN
- PYRETHRINS
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 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: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
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
Non-occupational
8. How did exposure occur? (Select all that apply)
Application
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.
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.)
1-52450722- The reporter indicates an exposure to two separate pesticides containing the active ingredients iron (present as FeHEDTA); and permethrin, pyrethrins, and N-octyl bicycloheptene dicarboximide. Approximately one hour before the time of initial contact with the registrant, the reporter indicated her husband was applying the both products outside the home, and now he was experiencing nausea. The reporter was advised that inhaling the product might cause respiratory irritation including nausea, but the symptom would be expected to dissipate after getting fresh air. On follow-up call four days later, the reporter indicated her husband's symptom had lessened after eating a meal and she thought the symptom might be from another cause. No additional information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.