Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-3875

2. Registrant Information.

Registrant Reference Number: 3646484

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

4. Date registrant was first informed of the incident.

30-JUN-23

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

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. 2217-991-239

Product Name: ORTHO WEEDCLEAR WEED KILLER READY-TO-USE (WAND)

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

Medical Professional

2. Demographic information of data subject

Sex: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Chills
  • Symptom - Fever
  • Symptom - Malaise
  • Symptom - Lethargy
  • Specify - Low energy levels

• Nervous and Muscular Systems
  • Symptom - Anxiety
  • Specify - Nervousness
  • Symptom - Shakiness

• Respiratory System
  • Symptom - Pneumonia
  • Specify - Fungal pneumonia

• Gastrointestinal System
  • Symptom - Loss of appetite

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Specify - Unable to self ambulate

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

Week(s) / Semaine(s)

7. Exposure scenario

Non-occupational

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

Contact with treated area

What was the activity? Pulling potentially treated weeds.

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.

Unknown

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.)

6/30/2023 Caller reporting that he applied this product to some weeds in his yard on approximately 06/15/23 and an individual pulled up the weeds after the product was applied and they have been experiencing nervousness, shakiness, fever, malaise and loss of appetite. The individual was doing yard work and pulling up weeds where the caller applied the product. The caller is not sure of when the person's symptoms began in correlation to them touching the weeds. The individual did tell the caller that they have been experiencing the above listed symptoms since approximately 06/16/23. The caller is not sure if the individual began pulling the weeds up the same day the product was applied or if it was the day after. The caller does not have much information on what has been done so far, but he knows that the individual has contacted a health care provider and they have been doing unknown testing to try to figure out what could be the cause. The caller wanted to call to see if these symptoms could be expected after touching the weeds with the product on them. 7/7/2023 Attempted callback and spoke with caller. He states the patient is getting better slowly. He will ask the patient to call us. 7/11/2023 Call back from caller: He clarifies the patient is his wife. Within the week of pulling the treated weeds (possibly while wearing gloves), her symptoms began. She went to a hospital for her symptoms 2-3 weeks ago, and was admitted for 1 week. Many tests were done (unsure what type), but the results were all normal. She was diagnosed with and treated for fungal pneumonia. Symptoms have improved (she is now eating and able to self-ambulate), but not resolved (energy remains somewhat low). Product was never mentioned to the doctors. Caller mentioned that his wife was exposed to either this or a similar product about 2-3 years ago with a similar reaction. That time, the symptoms took about 1 month to resolve.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.