Health Canada
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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-1825
2. Registrant Information.
Registrant Reference Number: x
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.
Packaging Failure
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
08-JUN-20Product 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.
Product Name: Item 659571 Advanced UV Sanitizer White
- Active Ingredient(s)
- DEVICE, NO GUARANTEE REQUIRED
7. b) Type of formulation.
Other (specify)
UV lightApplication Information
8. Product was applied?
No
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).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform VI: Packaging Failure
1. What is the type of packaging that failed?
Other / Autre
specify UV-C Sanitizing Device
2. Did packaging failure occur during?
Use of Product
3. Did packaging failure result in?
potential exposure
4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.
The following was reported: Item 659571 Advanced UV Sanitizer White. Sold by TSC The Shopping channel a Rogers Canada Company. Item is supposed to shut off if you open the lid while sanitizing a item . That does not happen. It continues to work. It is also supposed to be rechargeable which it is not.
