Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-4304

2. Registrant Information.

Registrant Reference Number: 3908713

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

Packaging Failure

4. Date registrant was first informed of the incident.

10-MAY-24

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

10-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. 30472      PMRA Submission No.       EPA Registration No.

Product Name: ORTHO HDCORE 4L WAND/4

• Active Ingredient(s)
  • PERMETHRIN

---

7. b) Type of formulation.

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.

Data Subject

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea

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)

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.

Respiratory

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

5/10/2024 The caller is reporting nausea for himself and daughter after driving their car with the product leaking in the trunk. The caller advised that about 3 and half hours ago, he purchased the product that had a broken wand and had been marked down by the store. The caller advised that while driving, it leaked in the trunk. He picked up his daughter about 30 minutes later. Upon returning home, they both started to feel nauseous. They have been getting fresh air since the exposure and the caller licked his finger after touching the bottle to get the information off the bar code. He suspects he could have ingested some of the product in the process of licking his finger, but cannot confirm. No known direct physical contact with the product is known to have occurred. The daughter is feeling better at the time of the call, but the caller is still feeling nauseous. 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.

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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea

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)

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.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

5/10/2024 The caller is reporting nausea for himself and daughter after driving their car with the product leaking in the trunk. The caller advised that about 3 and half hours ago, he purchased the product that had a broken wand and had been marked down by the store. The caller advised that while driving, it leaked in the trunk. He picked up his daughter about 30 minutes later. Upon returning home, they both started to feel nauseous. They have been getting fresh air since the exposure and the caller licked his finger after touching the bottle to get the information off the bar code. He suspects he could have ingested some of the product in the process of licking his finger, but cannot confirm. No known direct physical contact with the product is known to have occurred. The daughter is feeling better at the time of the call, but the caller is still feeling nauseous. 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.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Bottle-plastic / Bouteille-plastique

2. Did packaging failure occur during?

Transportation

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.

5/10/2024 The caller is reporting nausea for himself and daughter after driving their car with the product leaking in the trunk. The caller advised that about 3 and half hours ago, he purchased the product that had a broken wand and had been marked down by the store. The caller advised that while driving, it leaked in the trunk. He picked up his daughter about 30 minutes later. Upon returning home, they both started to feel nauseous. They have been getting fresh air since the exposure and the caller licked his finger after touching the bottle to get the information off the bar code. He suspects he could have ingested some of the product in the process of licking his finger, but cannot confirm. No known direct physical contact with the product is known to have occurred. The daughter is feeling better at the time of the call, but the caller is still feeling nauseous. No further information is available.

For Registrant use only

5. 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.