Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-9104

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-OCT-07

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

07-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. 26870      PMRA Submission No.       EPA Registration No.

Product Name: CIL Spiderban RTU

• Active Ingredient(s)
  • PERMETHRIN

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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).

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: Male

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Erythema
  • Symptom - Rash
  • Symptom - Pruritus

4. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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.)

The caller stated he used the product approximately 2 weeks ago (08/20/07). The patient stated he began exhibiting symptoms one week later (08/27/07). The patient reports he left the product on his skin for approximately 1 hour prior to removing his contaminated clothing and washing his skin. The patient stated he did go in to see his physician and was prescribed a cortisone cream, however he said it is not helping. The operator who fielded the call recommended the following steps to be taken:1) Gently wash skin well under gentle stream of comfortable temperature water for 15-20 minutes. 2) May also wash with mild soap, soaping 3 separate times.3) May use vitamin E oil on intact, decontaminated skin. 4) If symptoms persist or worsen, follow up with physician. 5) The MSDS can be faxed to the physician as needed. Subsequent follow up calls were scheduled and no response from the exposed caller.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.