Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-1671

2. Registrant Information.

Registrant Reference Number: 1109047

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.


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.


PMRA Registration No. 24723      PMRA Submission No.       EPA Registration No.

Product Name: OFF! Deep Woods 3 Insect Repellent 230g - Canada

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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?


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

3. List all symptoms, using the selections below.


  • Gastrointestinal System
    • Symptom - Vomiting
  • Nervous and Muscular Systems
    • Symptom - Muscle twitching
  • Skin
    • Symptom - Dry skin
  • Respiratory System
    • Symptom - Respiratory pain
  • Skin
    • Symptom - Discolouration
    • Specify - small pink spots
  • General
    • Symptom - Parasitism
    • Specify - tapeworm
    • Symptom - Parasitism
    • Specify - scabies
  • Respiratory System
    • Symptom - Respiratory pain
    • Specify - pain in left lower portion of lung
  • General
    • Symptom - Insomnia
    • Specify - given medication for sleep

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.


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


8. How did exposure occur? (Select all that apply)


9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)


10. Route(s) of exposure.


11. What was the length of exposure?

<=15 min / <=15 min

12. Time between exposure and onset of symptoms.

>8 hrs <=24 hrs / > 8 h < = 24 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.)

Jan. 23, 2013 Caller states bugs have been biting her in her sleep. She sprayed her body from head to toe with product while in her bathroom 1 week ago. The following day she had 1 episode of vomiting. She also reports that her skin became dry and she developed small pink spots that may be bug bites. She also sprayed her feet with product again on 1-19. She went to see a doctor on 1/22/2013 and was given an unspecified prescription. The caller states that her doctor diagnosed her with scabies and tapeworm, however, she doesn't not agree with this assessment. She states she also had twitching during her sleep last night but slept for 12 hours. She feels that she is having neurological symptoms and is calling to ask when they will go away. She is planning to see her psychiatrist later this week. Follow-up was completed with the patient on Jan. 28, 2013. The consumer again stated her doctor diagnosed her with scabies, however, her pharmacist confirmed that she does not have scabies. The consumer also reports that she recently experienced pain in her left lower portion of her lung, but that this has resolved. She was prescribed a medication by her psychiatrist for her sleep. She has not encountered any further twitching as previously reported.

To be determined by Registrant

14. Severity classification.


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. This product has been used outside of label directions for reasons other than as an insect repellent. The reported signs and symptoms are not suggestive of problems that may be linked to this insect repellent. It remains unclear if this consumer suffers from scabies, but that has been the diagnosis made by the consumer's doctor.