Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-3613

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-61774005

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.

25-JUL-20

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

25-JUL-20

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. 27800      PMRA Submission No.       EPA Registration No. Unknown

Product Name: ORTHO KILLEX READY-TO-USE LAWN WEED CONTROL HERBICIDE

• Active Ingredient(s)
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
  • MECOPROP-P (PRESENT AS DIMETHYLAMINE SALT)

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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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Other

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 - Blister
  • Symptom - Red skin

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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)

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.)

1-61774005 - The reporter, a homeowner, indicates an exposure to an herbicide containing the active ingredients mecoprop-p (present as amine salt), dicamba (present as acid, amine salt, ester, or sodium salt) and 2,4-D (present as acid). One day before the day of initial contact with the registrant, the reporter indicated his partner got some of the product on her forehead, then washed it off right away. On the day of initial contact, the reporter indicated his partners forehead was red and had small blisters (some of them open). The reporter was advised to seek medical attention for his partner, but the symptoms would be unlikely to indicate a toxicity. The reporter was not available on follow-up call two days later. On follow-up call three days later, the reporter indicated he had sought medical attention for his partner who was diagnosed with exposure to poison ivy. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.