Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-6035

2. Registrant Information.

Registrant Reference Number: 3682949

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

Address: 202-6835 Century Ave

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5N 7K2

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

Human

4. Date registrant was first informed of the incident.

07-AUG-23

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

07-AUG-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. 27201      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO ANT B GON ANT ELIM RTU BBY 1L/72

• Active Ingredient(s)
  • PERMETHRIN

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PMRA Registration No. 32259      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO ANIMAL B GON RTU 1L/12

• Active Ingredient(s)
  • DENATONIUM BENZOATE

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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: Unknown / Inconnu

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?

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: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Discolouration
  • Symptom - Irritated skin
  • Symptom - Other
  • Specify - Stinging sensation

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.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

8/7/2023 Email from consumer: I accidentally sprayed some of both products on my hands, and quickly felt a stinging sensation on both. I read your instructions regarding skin exposure, and did wash with soap and hot water for 10 minutes. Stinging disappeared, but I would just like to be aware of any possible health risks from this limited exposure. Please forward applicable Material Data Sheets for both products, and any advice or comments that you could offer, to alleviate any concerns that I might have. Would like to think that the active ingredients for both contain no cancer or other health risks for such small exposure. Product Name: Animal B Gon Max and Ant B Gon Max. 8/7/2023 Callback from caller. He stated that today (08/07/2023) around 7 hours ago, he used the products at which time he got them on his hands. Right away he developed a stinging sensation. He washed with soap and water for 10 minutes. The stinging sensation went away after rinsing. He also noticed a dark spot that is bluish purple on one of his hands and he is unsure if that is related. No further information is available.

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.