Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2524

2. Registrant Information.

Registrant Reference Number: 3910834

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.

13-MAY-24

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

12-MAY-24

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.       PMRA Submission No.       EPA Registration No. 239-2746

Product Name: ORTHO HOME DEFENSE MAX BED BUG, FLEA & TICK KILLER WAND

• Active Ingredient(s)
  • BIFENTHRIN
    • Unknown
  • IMIDACLOPRID
    • Unknown
  • PIPERONYL BUTOXIDE
    • Unknown

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

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.

Other

2. Demographic information of data subject

Sex: Male

Age: >12 <=19 yrs / >12 <=19 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Difficulty swallowing

• Nervous and Muscular Systems
  • Symptom - Slurred speech

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

No

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)

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

Other

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.

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.)

5/13/2024 Caller states her girlfriends son is having problems after using the product. He is not sure if he sprayed the product or ingested it. He is having slurred speech and swallowing problems since being exposed to the product 2 hours prior to calling. Caller states the child is saying he did not ingest the product but his mother states he did. No further details regarding ingestion could be provided. Caller could not determine how much product could potentially be missing from the bottle as it had already been used. 5/14/2024 Callback from caller. Caller states that he took his son to the emergency department last night. Teen was underwent magnetic resonance imaging which was unremarkable. Blood work came back with normal values. Teen was admitted to the hospital for observation. Teen did have a catheter put in. The doctor did not know what may be causing the symptoms and the teen was not diagnosed with anything. Caller thinks his son may have had a mini stroke but cannot say for sure. He was not given any medications or fluids in the hospital. Teen was discharged and came home this morning. Symptoms have all resolved. The teen stated that he did not drink the product. Caller states that no one actually saw him drink the product. No further information is available.

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.