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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-6143
2. Registrant Information.
Registrant Reference Number: PROSAR case: 1-35057268
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Argentia Road, Plaza 5, Suite 101
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N2R7
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
25-SEP-135. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
21-SEP-13Product 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. PMRA Submission No. EPA Registration No. Unknown
Product Name: Unknown
- Active Ingredient(s)
- CHLORPYRIFOS
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: Pub. Area - Indoor/Zone publique - int
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
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.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Applied in workplace. Worker was sitting at his or her desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Unknown
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Sitting at desk
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Applied in workplace. Worker sitting in their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace was treated. Sitting in their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace was treated. The worker was sitting in their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Applied in workplace. Worker was sitting at their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Applied in a workplace. Worker was sitting at their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Irritated skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace was treated. Worker was sitting at their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace treated. Worker was sitting in their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace treated. Worker sitting at their desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: Unknown / Inconnu
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Sitting in his or her office chair
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? The patient was sitting in his or her office desk.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Sitting at office work space
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting work area where product had recently been applied
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Workplace was treated with the product. Worker sitting at their work station.
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in her workplace
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
5. Was medical treatment provided? Provide details in question 13.
Unknown
6. a) Was the person hospitalized?
Unknown
6. b) For how long?
7. Exposure scenario
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Nervous and Muscular Systems
- Symptom - Headache
- Symptom - Dizziness
- Skin
- Symptom - Itchy skin
- Symptom - Rash
- Respiratory System
- Symptom - Shortness of breath
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Employee sitting in work area
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Other
2. Demographic information of data subject
Sex: Unknown
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Eye
- Symptom - Swollen eye
- Symptom - Irritated eye
4. How long did the symptoms last?
Unknown / Inconnu
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
Occupational
8. How did exposure occur? (Select all that apply)
Contact with treated area
What was the activity? Sitting at work space
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
Respiratory
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.)
1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.
To be determined by Registrant
14. Severity classification.
Minor
