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: 2007-7425

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-SEP-07

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-AUG-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 WIPEOUT TOTAL WEED & GRASS KILLER (RTU)

  • Active Ingredient(s)
    • GLUFOSINATE AMMONIUM

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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

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: Male

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

3. List all symptoms, using the selections below.

System

  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting

4. How long did the symptoms last?

Unknown / Inconnu

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

No

6. a) Was the person hospitalized?

Unknown

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 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.)

Caller stated he used the product the day before, and at about 4am he got up not feeling well, vomited several times and had diarrhea. He indicated that he wasn't aware of having contact with the product, but wanted to make sure the exposure was the cause of the problem. The operator who took call advised the caller that given the product and history especially length of time to onset of symptoms and the uncertainty re: actual exposure, it is very unlikely that the symptoms are related to use of this product. Recommendation was for the caller to follow up with family physician if symptoms persist or worsen. Follow up call denied.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.