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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-4704

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-57522547

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.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

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.

PMRA Registration No. 29301      PMRA Submission No.       EPA Registration No.

Product Name: SCOTTS ECOSENSE PATHCLEAR HERBICIDAL SOAP CONCENTRATE GRASS & WEED K

• Active Ingredient(s)
  • AMMONIUM SALTS OF HIGHER FATTY ACIDS

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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Tingling skin

• Nervous and Muscular Systems
  • Symptom - Numbness

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.

>2 hrs <=8 hrs / > 2 h < = 8 h

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.)

1-57522547 - The reporter, a homeowner, indicates an exposure to a pesticide containing the active ingredient ammonium salts of higher fatty acids. Two days before the day of initial contact with the registrant, the reporter indicated she applied the product outside her home, noticed the sprayer was leaking, then saw she got some of the product on her hand. The reporter indicated the affected area became numb about seven hours after exposure and the symptom persists. The reporter stated she thought the symptom could also be from her allergies, an insect bite, or a pinched nerve. The reporter was advised this would be an unusual reaction to normal product use and to seek medical attention should the symptom persist. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.