Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5556

2. Registrant Information.

Registrant Reference Number: 320032

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.

16-MAY-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

16-APR-08

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. 20796      PMRA Submission No.       EPA Registration No.

Product Name: Raid House and Garden Bug Killer 350 g (Canada)

• Active Ingredient(s)
  • D-TRANS ALLETHRIN
  • PIPERONYL BUTOXIDE
  • TETRAMETHRIN

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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: 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.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Erythema

4. How long did the symptoms last?

<=30 min / <=30 min

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

No

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)

Contact with treated area

Amount of time between application and contact 3

Day(s) / Jour(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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

5/16/2008 Caller reports that the product was sprayed on a window one month ago. Two or three days after product was applied, the caller's cat was in the room and began to thrash around and seemed to pass out. The cat's symptoms resolved within a few minutes. The caller did not witness the cat having any exposure to the area treated with the product. The caller then washed the area on the window where the product had been applied, and developed redness on both hands afterwards. Caller then washed both hands, and the redness resolved immediately.

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. There is nothing in the history provided by this user of the pesticide to indicate that the cat had any direct exposure to the pesticide or a surface treated with the pesticide. Secondly, even had incidental contact with a sprayed surface occurred, the concentration of pesticide in this product would not be associated with the type of symptoms reported in this cat, especially 2 to 3 days following pesticide application.

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

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

12.00

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

<=30 min / <=30 min

11. List all symptoms

System

• Cardiovascular System
  • Symptom - Fainting

• Nervous and Muscular Systems
  • Symptom - Agitation

12. How long did the symptoms last?

<=30 min / <=30 min

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

5/16/2008 Caller reports that the product was sprayed on a window one month ago. Two or three days after product was applied, the caller's cat was in the room and began to thrash around and seemed to pass out. The cat's symptoms resolved within a few minutes. The caller did not witness the cat having any exposure to the area treated with the product. The caller then washed the area on the window where the product had been applied, and developed redness on both hands afterwards. Caller then washed both hands, and the redness resolved immediately.

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To be determined by Registrant

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

Moderate

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. There is nothing in the history provided by this user of the pesticide to indicate that the cat had any direct exposure to the pesticide or a surface treated with the pesticide. Secondly, even had incidental contact with a sprayed surface occurred, the concentration of pesticide in this product would not be associated with the type of symptoms reported in this cat, especially 2 to 3 days following pesticide application.