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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-3741

2. Registrant Information.

Registrant Reference Number: 18355

Registrant Name (Full Legal Name no abbreviations): Woodstream Canada Corporation

Address: 25 Bramtree Court, Unit 1

City: Brampton

Prov / State: Ontario

Country: Canada

Postal Code: L6S 6G2

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

Environment

4. Date registrant was first informed of the incident.

17-JUL-17

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

17-JUL-17

Product Description

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

Active(s)

PMRA Registration No. 18355      PMRA Submission No.       EPA Registration No.

Product Name: Safer's Rose & Flower Insecticide R.T.U

  • Active Ingredient(s)
    • POTASSIUM SALTS OF FATTY ACIDS

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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

Product was applied 2x over the course of 7 days. Consumer shook the bottle well prior to applying the product onto the top and bottom of leaves/flowers in hanging basket. Several of the hanging flowers died, and several others were dying when the report was made.

To be determined by Registrant

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

Yes

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Herbaceous Plants / Plante herbacée

2. Common name(s)

Flowers

3. Scientific name(s)

Unknown

4. Number of organisms affected

5

5. Description of site where incident was observed

Fresh water

Terrestrial

Residential

Salt Water

6. Check all symptoms that apply

Death

Epinasty (leaf wilt)

7. Describe symptoms and outcome (died, recovered, etc.).

Flowers 2 of the plants in hanging baskets died, while the other 3 were dying as of the phone call.

8. a) Was the incident a result of (select all that apply)

Application

N/A

8. b) i) How many times has the product been applied this year?

2

8. b) ii) What was the date of the last application?

17-JUL-17

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Minor

13. Please provide supplemental information here