Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-7321
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.
Human
4. Date registrant was first informed of the incident.
12-JUL-07
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
08-JUN-07
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)
PMRA Registration No. 26200
PMRA Submission No.
EPA Registration No.
Product Name: Wilson Wasp and Hornet Killer
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: Unknown / Inconnu
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Product is an aerosol form and was applied to an existing wall structure where an insect nest of some sort existed.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
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: >64 yrs / > 64 ans
3. List all symptoms, using the selections below.
System
- Skin
- Symptom - Flushed
- Symptom - Erythema
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Yes
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)
Application
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>3 days <=1 wk / >3 jours <=1 sem
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.)
According to the consumer she used the product and days later a rash appeared on her legs. The product she was exposed to was some drift from an Aerosol that she had purchased to control some sort of wasp or bee. The consumer did receive cortisone cream and vitamin E topically for the rash symptoms were resolving.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
not convinced the label was followed accordingly. Lack of information to conclude whether or whether not the consumer did.