Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-2056

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 2022SCCA00041737

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.

12-APR-22

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

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. 33511      PMRA Submission No.       EPA Registration No. Unknown

Product Name: ORTHO ANT B GON MAX ANT KILLER GRANULES

• Active Ingredient(s)
  • PYRETHRINS

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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).

2022SCCA00041737 - Per the product label, the pesticide intended for outdoor use only.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

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: Male

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea
  • Symptom - Vomiting

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.

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.)

2022SCCA00041737 - The reporter indicates an exposure to a pesticide containing the active ingredient pyrethrins. Approximately two weeks before the day of initial contact with the registrant, the reporter applied the pesticide inside their home and an unknown amount of time later developed nausea. On the day of initial contact, the reporter stated they developed vomiting. The caller was advised the product should only be applied outdoors and they should remove the product from the home. The caller was advised to seek medical evaluation if the symptoms persisted once the product was removed. No additional information is available.

To be determined by Registrant

14. Severity classification.

Minor

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.