Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6716

2. Registrant Information.

Registrant Reference Number: SJB

Registrant Name (Full Legal Name no abbreviations): Spectrum Brands IP Inc.

Address: P.O. Box 21001

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3R 7W9

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


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


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. 17201      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Mosquito Fogging Insecticide

  • Active Ingredient(s)

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: Pub. Area - Outdoor/Zone publique - ext

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

The caller stated that she was at this campfire on June 30th where this guy had fogged for mosquitos. At the time she was 150-200 feet away at the cook shack and when she had decided to come out of the shack, she then sat down and became symptomatic. Product was applied with a propane fogger, size of area treated unknown.

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.


  • Respiratory System
    • Symptom - Chest congestion
  • Nervous and Muscular Systems
    • Symptom - Dizziness
  • Skin
    • Symptom - Pruritus
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness
  • Eye
    • Symptom - Red eye
  • General
    • Symptom - Edema
  • Nervous and Muscular Systems
    • Symptom - Collapse
  • Eye
    • Symptom - Conjunctivitis

4. How long did the symptoms last?

Unknown / Inconnu

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)

Contact with treated area

What was the activity? Campfire area (fogged for mosquitos)

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?

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.)

Caller stated that she was attending a campfire where this guy had fogged prior to everyone coming for the control mosquitos. Initially she was about 150 to 200 feet away at the cook shack and when she came out of the shack and sat down, she became symptomatic. When asked for medical history the caller informed the operator that she is highly allergic to many chemicals which began 3 years ago when allergies started to act up. She stated that she is (age) yo and has severe weeping eczema and was on steroids but had a bad reaction to them. She also indicated that she is highly allergic to shellfish and now carries an epi pen bec as a result of this exposure.10 years ago she was diagnosed fibromyalgia and has been on trazodone to help make her sleepy. She had indicated immediately after being exposed to the treated area that she experienced nausea, headaches and then thru the next few hours lost mobility, developed red eye (irritable and itchy), left side of the face started to swell and when had to speak out loud had no vocal chords. Also she explained that this was the most frightening experience for her and that she felt severe pain in chest area, gripping like spasms and felt like darts in lung/heart area on left side of the body. When asked did you go an seek medical? She told the operator that she did not go to the doctor on June 30th which was a Saturday, however she did get in on July 9th and told him of the situation and as a result he prescribed her an epi pen. When asked if she was doing okay now? - She told the operator that she still has a froggy voice - not just from mosquito thing, but also from a deck cushion, which she did not have proper instructions on storage and it had developed mold and mildew. When she became exposed to it, she had lost her voice and developed headaches -still not feeling real real well. On July 23, 2007 after several days went by trying to fax the MSDS to the doctors office, the caller was contacted by phone as to what the final outcome was and she indicated that her doctor gave her a vaccine but it would not help deal with other reaction to the product. Still doesn't feel well but doesn't know what it is due to. Lungs feels like clearing

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

It is hard to confirm as to whether the product was responsible for the onset of all the symptoms listed above. She indicated to the operator that fielded the call that she is prone to and has developed highly sensitive allergies which she cannot always pin point what is causing the symptom to flare up.