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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4564

2. Registrant Information.

Registrant Reference Number: 189270

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.


4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: FLORIDA

6. Date incident was first observed.


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.


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

Product Name: OFF! Active Insect Repellent 1 (Orange Can) - 6 oz. Aerosol - US

  • Active Ingredient(s)
      • Guarantee/concentration 15 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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

Site: Personal use / Usage personnel

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

See main notes on subform II

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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.


  • Skin
    • Symptom - Burns (2nd or 3rd degree)
    • Symptom - Hair loss
    • Symptom - Discolouration

4. How long did the symptoms last?

>6 mos / > 6 mois

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

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

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 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.)

5/21/2007 Consumer states that on Oct 17, 2005 the she used the product on her face. An unspecified period of time later, she attempted to light a home-made wood fire grill by soaking the wood in gasoline prior to igniting it. When she ignited the fire it exploded. Caller states the OFF! product on her face also ignited. Caller had severe burns on her face, arms, torso, vaginal area, and legs. Caller was seen at the ER for treatment of the burns. Had skin missing from lips, nose, and face. Took burns 5-6 months to heal. Caller stated that her skin is still very sensitive to sun light, feels like it is burning when out in the sunlight for an extended amount of time. She was never admitted into a hospital. She has been treated on an outpatient basis.

To be determined by Registrant

14. Severity classification.


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. Given the unusual nature of this patient's history and the fact that she used gasoline to start a wood fire, facial burns are likely a result of the direct exposure to the flames from the wood fire. If a period of 30 minutes to an hour had elapsed between the time she applied product to her face and when she lit the fire, the ethanol in the repellent likely would have completely evaporated off the skin.