Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-7154

2. Registrant Information.

Registrant Reference Number: 2019-MCA

Registrant Name (Full Legal Name no abbreviations): Timber Specialties Limited

Address: 35 Crawford Crescent, P.O. BOX 520

City: Campbellville

Prov / State: Ontario

Country: Canada

Postal Code: L0P 1B0

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

Human

4. Date registrant was first informed of the incident.

06-MAR-19

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

Unknown

Product Description

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

Active(s)

---

PMRA Registration No. 30196      PMRA Submission No.       EPA Registration No.

Product Name: Wood treated with MicroPro 200C-TS and other products

• Active Ingredient(s)
  • COPPER, PRESENT AS BASIC COPPER CARBONATE

---

PMRA Registration No. 30379      PMRA Submission No.       EPA Registration No.

Product Name: Wood treated with MTZ and other products

• Active Ingredient(s)
  • TEBUCONAZOLE

---

PMRA Registration No. 28013      PMRA Submission No.       EPA Registration No.

Product Name: Wood treated with Thor Acticide 14 Industrial Microbiocide and others

• Active Ingredient(s)
  • 2-METHYL-4-ISOTHIAZOLIN-3-ONE
  • 5-CHLORO-2-METHYL-4-ISOTHIAZOLIN-3-ONE

---

PMRA Registration No. 27271      PMRA Submission No.       EPA Registration No.

Product Name: Wood treated with Thor Acticide 45 Mildewcide and others

• Active Ingredient(s)
  • 2-N-OCTYL-4-ISOTHIAZOLIN-3-ONE

---

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: Industrial / Industriel

Préciser le type: wood treatment

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

Wood was pressure treated with a tank mix of the pesticide products listed above. Registrant does not know the application rate or size.

To be determined by Registrant

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

Unknown

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

1. Source of Report.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Inflammation of the skin

• General
  • Symptom - Anaphylaxis
  • Specify - possible swelling of throat
  • Symptom - Edema

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Unknown

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

Contact with treated area

What was the activity? installation of wooden fence, wood was treated with listed products

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

11. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

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.)

Person stated she experienced swelling on hands, forearms and possible swelling in her throat after working a few hours with the wood to build a fence with her husband. She took an anti-histamine which reduced symptoms and said she was later okay.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

The treater who supplied the wood recently introduced MicroPro-treated wood to the retailer. We also believe the treated changed the species of wood. Some individuals are allergic to certain wood species.