Health Canada
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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-5983

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.

Human

Packaging Failure

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

15-JUL-20

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. 22137      PMRA Submission No.       EPA Registration No.

Product Name: COUNTER ASSAULT ULTRA BEAR DETERRENT

  • Active Ingredient(s)
    • CAPSAICIN
      • Guarantee/concentration 2 %

7. b) Type of formulation.

pressurized product

Application Information

8. Product was applied?

No

9. Application Rate.

Unknown

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

Site: Unknown / Inconnu

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

While my daughter and friend were in the car, the can of bear spray went off both out of the nozzle and leaked down the side of the can. The can was not hot from the sun. No one was touching the can and the safety was still intact.

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: >6 <=12 yrs / > 6 < = 12 ans

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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

10. Route(s) of exposure.

Eye

Oral

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

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: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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

10. Route(s) of exposure.

Eye

Oral

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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

10. Route(s) of exposure.

Eye

Oral

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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

10. Route(s) of exposure.

Eye

Oral

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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

10. Route(s) of exposure.

Eye

Oral

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

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: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • Eye
    • Symptom - Burning eye
  • Respiratory System
    • Symptom - Burning lungs
    • Symptom - Burning nose

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

Non-occupational

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

Other

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.)

Our family purchased a can of bear spray from X store this summer as protection from wildlife while hiking. On July 15 (within a day or 2 of that), my wife, 2 daughters, a Friend, and her two daughters went for a hike. My daughter and friend got bearspray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car.The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Pressurized product /Prod. sous pression

2. Did packaging failure occur during?

Other

specify product was in passenger compartment of car; unclear if it had been stored there or if was simply placed in car during drive.

3. Did packaging failure result in?

potential injury

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

While my daughter and friend were in the car, the can of bear spray went off both out of the nozzle and leaked down the side of the can. The can was not hot from the sun. No one was touching the can and the safety was still intact. My daughter and friend got bear spray in their eyes, nose, and mouth and the car was filled with it. All 6 of them were exposed seriously to the spray as they needed to ride home in the car. The car interior was damaged and our friends needed to have the car professionally cleaned and even after, suffered from burning eyes, nose, and lungs for weeks.

For Registrant use only

5. Provide supplemental information here.