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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7323

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: ONTARIO

6. Date incident was first observed.

14-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. 25300      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Total Wipeout RTU

  • Active Ingredient(s)
    • GLUFOSINATE AMMONIUM

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).

unknown

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: Female

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

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Swollen eye
  • Skin
    • Symptom - Burning skin
    • Symptom - Red skin

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)

Pesticide Spill

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.

Skin

Eye

11. What was the length of exposure?

Unknown / Inconnu

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.)

(age) female caller stated that she used the product and accidently spilled some on her hands. Without realizing that the product was still on her hands she had rubbed her face. After realizing what she had done, she washed her face with soap and water and applied ice to her face with no relief. She also stated that her eyes nearly swelled shut, with a red and burning sensation within 30 minutes. The operator who fielded the call advised the caller to go an seek medical advice right away. Caller then called back to inform the operator that the local emergency department did see her and had advised her that her adverse reaction is most likely a result from the exposure to the product, however they could not prescribe any medication as a result of what she is taking already. It is unknown as to how long it took the exposed female caller to recover from onset symptoms.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.