Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-0284

2. Registrant Information.

Registrant Reference Number: BC MOE

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA


6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


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

Product Name: unknown

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Hello my name is (first name, last name). I have been living in low cost housing (BC Housing) for 7 years now. The reason I am contacting you is that I have been trying to hold BC Housing accountable for one of their building managers ordering pest control techs to spray my bed, pillows, linens, couch chairs etc. Which as I understand it is against regulations. Here is a transcript of the most recent transmissions between myself and (first name, last name), (first name, last name), and (first name, last name). The complaints resolution person, the property portfolio manager, and their bedbug expert respectively: The following is a transmission from BC Housing in reply to my enquiry regarding BC Housing holding one of their building managers accountable for breaking the Health Canada regulations regarding the safe use of Permethrin / pyrethrins as a pest control tool.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Respiratory System
    • Symptom - Other
    • Specify - collapsed lung
    • Symptom - Pneumonia
    • Specify - double pneumonia

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?


Week(s) / Semaine(s)

7. Exposure scenario


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

Contact with treated area

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


10. Route(s) of exposure.


11. What was the length of exposure?

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.)

(First name) an interim manager here at (company name), a low cost housing complex in the (city area); whilst in my presence ordered then pest control company to drench my furniture and linens, pillows in the aforementioned chemical weapons. Yes this substance is on the chemical weapon convention act list. Which is a clear cut violation of Health Canada regulations. By there regulations they are not permitted to spray directly onto beds, couches chair pillows since when one sits or lies down the substance is released into the air and you breathe it in The pest control tech said "we are not allowed to do that". (first name) reply was "You can and you will". At the time I was unaware of any facts about these very dangerous agents being used so recklessly in my home. 2 weeks later I began a 12 week stay in (name) memorial hospital for a collapsed lung on one side and double pneumonia in the other. I very nearly died. When I came home from the hospital (name) was gone and BC Housing had switched pest control companies. There is a file with (name) pest control which was allegedly investigated by someone from your office, which will confirm that what I am telling you has at least enough basis of truth in it for you or one of your delegates to investigate this. The technician told me that they knew and that is why they switched companies, and that they are now engaged in trying to evict me before anyone takes me seriously. After 1 year of stalling and not giving me an answer this is the message I received fromi (name): BC Housing's complaints resolution process does not apply if other appropriate legislation exists to address concerns.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.