Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-6544

2. Registrant Information.

Registrant Reference Number: 3365603

Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

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

Human

Packaging Failure

4. Date registrant was first informed of the incident.

26-AUG-22

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

17-AUG-22

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. 30746      PMRA Submission No.       EPA Registration No.

Product Name: RAID Max Wasp & Hornet Foam Bug Killer 2, 500g [Canada]

• Active Ingredient(s)
  • D-PHENOTHRIN
  • TETRAMETHRIN

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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. - 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.

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

• Skin
  • Symptom - Other
  • Specify - Animal sting
  • Symptom - Red skin

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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.

Unknown

11. What was the length of exposure?

<=15 min / <=15 min

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.)

8/26/2022 A consumer email was forwarded for documentation. The email states that caller's husband was spraying product in a hornet nest two days ago. There was something wrong with the sprayer, and it was sputtering and spraying erratically. Husband moved closer to the hole to try to get as much foam as he could out of the bottle, and the hornets were getting out of the hole. Caller was nearby and was stung 3 times. Call from the consumer. Consumer reporting a product quality complaint of a faulty sprayer nozzle after using the product in her mother's yard on the evening of 08/17/22. She shook the can for several minutes then her husband stood back about 1 meter from the nest while the caller held up her phone as a flashlight. When he went to spray the nest, the spray arched out a few centimeters and began sputtering. He tried moving in closer to at least get some of the product into the nest but some of the hornets began flying out as they were becoming agitated and one flew right at the caller. She could feel one go into her shirt so she had to pull off her shirt while in the driveway then run into the house. She was stung 3 times. The stings have healed and the area is just a little red where they were. She believes this can had a defective sprayer. She has thrown out the can already so it cannot be retrieved.

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?

Pressurized product /Prod. sous pression

2. Did packaging failure occur during?

Use of Product

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

8/26/2022 A consumer email was forwarded for documentation. The email states that caller's husband was spraying product in a hornet nest two days ago. There was something wrong with the sprayer, and it was sputtering and spraying erratically. Husband moved closer to the hole to try to get as much foam as he could out of the bottle, and the hornets were getting out of the hole. Caller was nearby and was stung 3 times. Call from the consumer. Consumer reporting a product quality complaint of a faulty sprayer nozzle after using the product in her mother's yard on the evening of 08/17/22. She shook the can for several minutes then her husband stood back about 1 meter from the nest while the caller held up her phone as a flashlight. When he went to spray the nest, the spray arched out a few centimeters and began sputtering. He tried moving in closer to at least get some of the product into the nest but some of the hornets began flying out as they were becoming agitated and one flew right at the caller. She could feel one go into her shirt so she had to pull off her shirt while in the driveway then run into the house. She was stung 3 times. The stings have healed and the area is just a little red where they were. She believes this can had a defective sprayer. She has thrown out the can already so it cannot be retrieved.

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.