Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-4805
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 1-62222045
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.
09-SEP-20
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
05-SEP-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. Unknown
Product Name: ORTHO WEED B GON MAX CONCENTRATE
- Active Ingredient(s)
- DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
- MCPA (PRESENT AS AMINE SALTS: DIETHANOLAMINE, DIMETHYLAMINE, OR MIXED AMINES)
- TRICLOPYR TRIETHYLAMINE SALT
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
mixed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.75
7. Weight (provide a range if necessary )
12.5
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
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?
Other / Autre
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-62222045 - The reporter, a pet owner, indicates an exposure to a pesticide containing the active ingredients dicamba(present as acid, amine salt, ester, or sodium salt), MCPA(present as amine salts: diethanolamine, dimethylamine, or mixed amines), and triclopyr triethylamine salt. An unknown number of days before the day of initial contact with the registrant, the reporter applied the diluted product outside the home and her 9-month-old, 12.5-pound, male, mixed breed dog was not allowed on the treated area for 24-hours. One day before the day of initial contact, the dog started gagging which continued through to the time of contact. The reporter was advised to seek veterinary care for the dog due to the persistence of symptoms, but it would be unusual for the symptoms to be caused by the described exposure. The reporter was not available on follow-up call two and five days later. 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