Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-0835

2. Registrant Information.

Registrant Reference Number: 277283

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

4. Date registrant was first informed of the incident.

08-JAN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ARKANSAS

6. Date incident was first observed.

Unknown

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.

Product Name: Raid Flying Insect Killer Formula 6 Outdoor Fresh Scent 18 oz.

• Active Ingredient(s)
  • D-CIS, TRANS ALLETHRIN
    • Guarantee/concentration .1 %
  • PERMETHRIN
    • Guarantee/concentration .1 %
  • TETRAMETHRIN
    • Guarantee/concentration .35 %

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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: Personal use / Usage personnel

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?

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Blood
  • Symptom - Hyperglycemia
  • Symptom - Acidosis

• Respiratory System
  • Symptom - Respiratory failure

4. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

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?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1/8/2008Email from a physician treating a patient that intentionally exposed self to product. Physician is requesting product ingredients.Call was placed to physician to provide information. Unable to reach physician, and a an email reply was sent to the physician.1/9/2008Physician calling, and reports that patient has been regularly spraying self with product to keep flies off. The patient has had two prior admissions for metabolic acidosis, and the cause has not been determined. Lactates were normal during each admission. Patient was in respiratory failure on the most recent admission. The patient was intubated and treated with sodium bicarbonate, and recovered. Patient has a medical history of Type II Diabetes Mellitus.1/23/2008Call back attempted to hospital, and physician did not answer the page. An email was sent to physician requesting any additional information regarding the cause of patient's symptoms.

To be determined by Registrant

14. Severity classification.

Major

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. The signs and symptoms reported in this case are not consistent with the known toxicology of the material involved at the concentrations used in this spray, even following the type of gross misuse us of the product by the patient. The weight of medical and scientific evidence does not support a correlation between this patient's illness and the type of skin exposure as reported in this case. Ready-to-use pyrethroid based house insect sprays such as this product have a very wide margin of safety, such that even direct skin contact with spray would not be expected to cause any complications other than possibly localized skin irritation. It is important to note that many over-the-counter products used to treat human head lice typically contain pyrethroid class insecticides including permethrin at concentrations/potencies higher than that used in this spray product.