Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-3894

2. Registrant Information.

Registrant Reference Number: 3580908

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.

22-APR-23

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

08-APR-23

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. 27521      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HOME DEFENSE MAX INDOOR INSECT CONTROL RTU 709ML/12

• Active Ingredient(s)
  • PERMETHRIN

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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).

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: Female

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Other
  • Specify - Oropharyngeal edema
  • Symptom - Irritated throat
  • Symptom - Burning throat
  • Symptom - Other
  • Specify - Feels as though something is in throat

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

No

6. a) Was the person hospitalized?

No

6. b) For how long?

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

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 h

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.)

4/22/2023 Caller states that her throat has burning irritation after exposure to the product. Caller states that around 4/8/2023 she sprayed the product around the baseboards. She states that in the middle of night she began to experience the burning irritation her throat. She states that her symptoms persist. She used vinegar to clean up the sprayed areas. She is wondering if the product can be causing her symptoms. 4/24/2023 Attempted call back. Left a detailed message requesting a call back. Case and call back numbers provided. 4/24/2023 Consumer is reaching out after receiving a voicemail from this department. Consumer reports that she tried to go to walk-in-clinic but was unable to be seen. She has an appointment to see her doctor next week and plans to keep it if her symptoms are still persisting. Per consumer, her throat was initially swollen and the back of her mouth/throat appeared red following the exposure. She has been using a medicated throat spray which has helped and the swelling and redness have subsided. She stated that she feels a lot better but still feels as though there is something in her throat. 4/25/2023 Attempted call back. No answer. Left message with reason for the call, and case and callback numbers.

To be determined by Registrant

14. Severity classification.

Minor

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.