Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7426

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: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

28-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)

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PMRA Registration No. 17971      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Liquid Sevin Insecticide17971

• Active Ingredient(s)
  • CARBARYL
    • Guarantee/concentration 22.5 %

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7. b) Type of formulation.

Liquid

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.

Other

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Fever

• Nervous and Muscular Systems
  • Symptom - Muscle pain

• General
  • Symptom - Joint pain

• Skin
  • Symptom - Rash

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

Amount of time between application and contact 24

Hour(s) / Heure(s)

What was the activity? Trimming a rose bush

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.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

A concerned mother stated her son (age) was exposed to product and she is concerned that he is having an allergic reaction. Her husband applied to rose bush at sons house. The son the trimmed the bush the next day and within 24 hours he wasn't feeling well. Time of exposure was one week ago. Symptoms presented were a fever of 103.5,muscle aches, joint aches, rash on his extremities and had a cough before this exposure. The operator who fielded the call advised the concerned mother that the symptoms are not consistent with this exposure. The spray had dried by the time he was exposed and strongly recommends to follow up with MD to rule out medical causes.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.