Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-6475

2. Registrant Information.

Registrant Reference Number: 3430019

Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.

Address: 2000 Argentia Road - Plaza 2 Suite 300

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5N1V8

3. Select the appropriate subform(s) for the incident.

Human

Packaging Failure

4. Date registrant was first informed of the incident.

07-NOV-22

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 73327-18

Product Name: ACE WEED & GRASS KILLER CONCENTRATE2

• Active Ingredient(s)
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Unknown
  • DIQUAT
    • Unknown
  • FLUAZIFOP-P-BUTYL
    • Unknown

---

7. b) Type of formulation.

Liquid

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

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

Yes

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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Insomnia
  • Symptom - Numbness

• Skin
  • Symptom - Irritated skin
  • Symptom - Rash
  • Symptom - Other
  • Specify - Skin warm
  • Symptom - Other
  • Specify - Shingles

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Fever
  • Symptom - Pain
  • Symptom - Other
  • Specify - Cannot bend fingers sideways

• Skin
  • Symptom - Other
  • Specify - Hot sensation on right hand

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?

1

Day(s) / Jour(s)

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Application

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Pesticide Spill

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>1 wk <=1 mo / > 1 sem < = 1 mois

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.)

11/7/2022 Around mid-August 2022 the consumer was spraying the diluted product when the line fell off the sprayer, causing it to spray product onto his hand and wrist. He briefly rinsed exposed skin an unspecified amount of time later and remained asymptomatic initially after doing so. On September 1st, 2022 he began experiencing pain in his wrist, and several days later developed a rash on his wrist and arm. He was diagnosed with shingles and prescribed Valtrex by his doctor an unspecified period of time later. The Valtrex helped with the pain radiating up his arm, but did not help with pain present in his palm. He has since developed difficulty sleeping due to the pain, and his pinky finger on the affected hand is now numb. His doctor additionally prescribed Lyrica and Gabapentin, but the pain has intensified and the only thing that helps is putting his hand on ice. He was started on a second course of Valtrex by his primary care doctor on November 3rd, 2022 and given a list of neurologists so he could schedule an electromyography. He additionally began seeing an orthopedist who advised they had never seen effects like his caused by shingles, but did not believe the symptoms were caused by the product, either. 11/11/22 Follow up with the consumer revealed no improvement in symptoms, and he now reports his ring finger is also numb and he cannot bend his fingers sideways. He additionally has a hot sensation on his right hand. He has also added Salonpas and Naproxen to his course of treatments. He has scheduled an electromyography for November 18th, 2022. 11/21/22 Additional follow up revealed that the consumer completed his electromyography on November 18th, 2022 but needed to schedule another visit to go over results. 12/7/22 Additional follow up revealed the consumer received results from his electromyography on December 2nd, 2022 and was told again by the physician they felt his effects were due to shingles. He was prescribed another course of Valtrex and Gabapentin. 12/7/22 Additional follow up from the consumer was received. He noted that he forgot to mention going to the emergency room on December 4th, 2022 for vomiting and a fever. He was admitted to overnight and given one bag of intravenous fluids, Zofran, and Tylenol. He additionally underwent two electrocardiograms, unknown bloodwork, and had a computerized tomography scan of his abdomen, all of which were within normal limits and unremarkable. The doctors did not know the cause of his symptoms and he was discharged on December 5th, 2022 with Zofran and a diagnosis of vomiting of unknown origin. No further information is available at this time.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Spray Bottle / Flacon pulvérisateur

2. Did packaging failure occur during?

Use of Product

3. Did packaging failure result in?

potential injury

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

11/7/2022 Around mid-August 2022 the consumer was spraying the diluted product when the line fell off the sprayer, causing it to spray product onto his hand and wrist. He briefly rinsed exposed skin an unspecified amount of time later and remained asymptomatic initially after doing so. On September 1st, 2022 he began experiencing pain in his wrist, and several days later developed a rash on his wrist and arm. He was diagnosed with shingles and prescribed Valtrex by his doctor an unspecified period of time later. The Valtrex helped with the pain radiating up his arm, but did not help with pain present in his palm. He has since developed difficulty sleeping due to the pain, and his pinky finger on the affected hand is now numb. His doctor additionally prescribed Lyrica and Gabapentin, but the pain has intensified and the only thing that helps is putting his hand on ice. He was started on a second course of Valtrex by his primary care doctor on November 3rd, 2022 and given a list of neurologists so he could schedule an electromyography. He additionally began seeing an orthopedist who advised they had never seen effects like his caused by shingles, but did not believe the symptoms were caused by the product, either. 11/11/22 Follow up with the consumer revealed no improvement in symptoms, and he now reports his ring finger is also numb and he cannot bend his fingers sideways. He additionally has a hot sensation on his right hand. He has also added Salonpas and Naproxen to his course of treatments. He has scheduled an electromyography for November 18th, 2022. 11/21/22 Additional follow up revealed that the consumer completed his electromyography on November 18th, 2022 but needed to schedule another visit to go over results. 12/7/22 Additional follow up revealed the consumer received results from his electromyography on December 2nd, 2022 and was told again by the physician they felt his effects were due to shingles. He was prescribed another course of Valtrex and Gabapentin. 12/7/22 Additional follow up from the consumer was received. He noted that he forgot to mention going to the emergency room on December 4th, 2022 for vomiting and a fever. He was admitted to overnight and given one bag of intravenous fluids, Zofran, and Tylenol. He additionally underwent two electrocardiograms, unknown bloodwork, and had a computerized tomography scan of his abdomen, all of which were within normal limits and unremarkable. The doctors did not know the cause of his symptoms and he was discharged on December 5th, 2022 with Zofran and a diagnosis of vomiting of unknown origin. No further information is available at this time.

For Registrant use only

5. Provide supplemental information here.