Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7990

2. Registrant Information.

Registrant Reference Number: 236177

Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

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

Human

Domestic Animal

4. Date registrant was first informed of the incident.

11-SEP-07

5. Location of incident.

Country: UNITED STATES

Prov / State: DELAWARE

6. Date incident was first observed.

09-SEP-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.       PMRA Submission No.       EPA Registration No. 4822-273

Product Name: Raid Flea Killer Plus Carpet and Room Spray 16 oz4822-273

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .015 %
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration 1 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration 1 %
  • PYRETHRINS
    • Guarantee/concentration .14 %
  • TETRAMETHRIN
    • Guarantee/concentration .063 %

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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. - In Home / Rés. - à l'int. maison

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

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: >1 <=6 yrs / > 1 < = 6 ans

3. List all symptoms, using the selections below.

System

• Respiratory System
  • Symptom - Coughing

4. How long did the symptoms last?

>3 days <=1 wk / >3 jours <=1 sem

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)

Contact with treated area

Amount of time between application and contact 8

Hour(s) / Heure(s)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

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

11. What was the length of exposure?

<=15 min / <=15 min

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.)

9/11/2007Caller's husband used the product in one room of her house on previous Sunday. Within 8 hours of use, the grandson developed a cough. Within 8 hours of using the product the cat developed labored breathing. The cat also stopped eating and drinking. There is no known exposure to the product other than the possibility that the cat could have walked on the treated carpeting.Cat was taken to DVM the next morning where he was diagnosed with a collapsed lung and was euthanised. No necropsy was not performed. The DVM did not necessarily feel the carpet product was responsible but was unsure of the ultimate cause.Follow-up on 9/12/2007Grandmother states that her grandson is okay now, his cough is getting better. They think maybe it was from his cold that he apparently had before the product was used. He did not see a doctor.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.These signs and symptoms are not specific for the known toxicity profile of the product given the circumstances of use and the suspected exposure. Even with incidental contact with treated areas, this pesticide is most certainly not associated with the development of a collapsed lung. Secondly, the human patient reported in this case already had evidence of an upper respiratory infection prior to the use of the pesticide with the subsequent symptoms being far more consistent with some type of respiratory virus.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

19.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• Respiratory System
  • Symptom - Shortness of breath

• General
  • Symptom - Adipsia

• Respiratory System
  • Symptom - Other
  • Specify - collapsed lung

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

15. Outcome of the incident

Euthanised / Euthanasie

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

9/11/2007Caller's husband used the product in one room of her house on previous Sunday. Within 8 hours of use, the grandson developed a cough. Within 8 hours of using the product the cat developed labored breathing. The cat also stopped eating and drinking. There is no known exposure to the product other than the possibility that the cat could have walked on the treated carpeting.Cat was taken to DVM the next morning where he was diagnosed with a collapsed lung and was euthanised. No necropsy was not performed. The DVM did not necessarily feel the carpet product was responsible but was unsure of the ultimate cause.Follow-up on 9/12/2007Grandmother states that her grandson is okay now, his cough is getting better. They think maybe it was from his cold that he apparently had before the product was used. He did not see a doctor.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.These signs and symptoms are not specific for the known toxicity profile of the product given the circumstances of use and the suspected exposure. Even with incidental contact with treated areas, this pesticide is most certainly not associated with the development of a collapsed lung. Secondly, the human patient reported in this case already had evidence of an upper respiratory infection prior to the use of the pesticide with the subsequent symptoms being far more consistent with some type of respiratory virus.