Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0678

2. Registrant Information.

Registrant Reference Number: 728674

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.

Domestic Animal

Packaging Failure

4. Date registrant was first informed of the incident.

08-DEC-10

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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)

---

PMRA Registration No. 26909      PMRA Submission No.       EPA Registration No.

Product Name: Raid EarthBlends Multi-Bug Killer Aerosol 350g - Canada

• Active Ingredient(s)
  • PIPERONYL BUTOXIDE
  • PYRETHRINS

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 4822-452

Product Name: Raid Concentrated Deep Reach Fogger

• Active Ingredient(s)
  • CYPERMETHRIN

---

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Fish / Poisson

3. Breed

Freshwater Fish

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Died

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

12/8/2010 The consumer states in an email that she sent to the company that the top cover on the Raid EarthBlends Multi-Bug Killer was broken and the product did not spray properly when she applied it in her home at an unspecified period of time. Call states she also used an unspecified number of cans of what she described as Raid Concentrated Deep Reach Fogger in her home. She reportedly took her fish bowl out of the home before using the foggers. Upon returning to her home the next day with the fish bowl, her fish reportedly died an unspecified period of time later. In her email, the consumer did not explain where she acquired the Raid Concentrated Deep Reach Fogger. There is no such product sold in Canada by SC Johnson, however, there is a formula sold in the USA that goes by this name and contains cypermethrin as an active ingredient. Follow-up with the consumer was attempted with the phone number she provided, however, this number was not a working number. An email was also sent to the consumer requesting her follow-up but she did not reply or call back.

---

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. It is difficult to ascertain how the consumer's fish may have been exposed to any pesticides used in her home, especially given that she did not provide any time references of when the pesticides were used verses when her fish died. Other factors such as the cold weather would certainly need to be considered given that the fish were transported outside of the home while in a fish bowl.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Pressurized product /Prod. sous pression

2. Did packaging failure occur during?

Storage

3. Did packaging failure result in?

potential exposure

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

12/8/2010 The consumer states in an email that she sent to the company that the top cover on the Raid EarthBlends Multi-Bug Killer was broken and the product did not spray properly when she applied it in her home at an unspecified period of time. Call states she also used an unspecified number of Raid foggers in her home. She reportedly took her fish bowl out of the home before using the foggers. Upon returning to her home the next day with the fish bowl, her fish reportedly died an unspecified period of time later.

For Registrant use only

5. 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. It is difficult to ascertain how the consumer's fish may have been exposed to any pesticides used in her home, especially given that she did not provide any time references of when the pesticides were used verses when her fish died. Other factors such as the cold weather would certainly need to be considered given that the fish were transported outside of the home while in a fish bowl.