Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-6315

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2021SCCA00030694

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.

18-NOV-21

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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. 32674      PMRA Submission No.       EPA Registration No. Unknown

Product Name: ORTHO BED BUG B GON DIATOM DIATOMACEOUS EARTH BED BUG KILLER

• Active Ingredient(s)
  • SILICON DIOXIDE (PRESENT AS 100% DIATOMACEOUS EARTH) - FRESH WATER FOSSILS

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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. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

2021SCCA00030694 - The reporter stated they had four cans of the pesticide and applied one can per day over an unknown amount of time to an unoccupied bedroom in their home.

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

• General
  • Symptom - Lethargy

• Liver
  • Symptom - Elevated liver enzymes

• Gastrointestinal System
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - Barely conscious

• Blood
  • Symptom - Leukocytosis

• Gastrointestinal System
  • Symptom - Stomachache

• General
  • Symptom - Fatigue
  • Symptom - Malaise

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?

Yes

6. b) For how long?

Unknown

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.

Respiratory

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.)

2021SCCA00030694 - The reporter indicates an exposure to a pesticide containing the active ingredient silicon dioxide (present as 100% diatomaceous earth). Approximately seven weeks before the day of initial contact with the registrant, the reporter applied the product in their home for several days. The reporter stated that one day after the last day of application, they developed lethargy and vomiting so they sought medical evaluation and were hospitalized for over one week during which they were barely conscious and had elevated liver values. The reporter indicated they were discharged from the hospital one month before the day of initial contact, but still did not feel well. Two days before the day of initial contact, the reporter stated that blood tests indicated their white blood cell count was elevated, but their liver values had returned to normal. The reporter stated their stomach bothers them every time they eat and they get exhausted with minimal exertion. The reporter was advised their symptoms are not an expected effect of exposure to the product. No additional information is available.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Please note that this submission in no way implies that Scotts Canada Ltd. agrees with the allegations contained within this incident report.