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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-3778

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

4. Date registrant was first informed of the incident.

26-JUL-21

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

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.

Active(s)

PMRA Registration No. 32473      PMRA Submission No.       EPA Registration No.

Product Name: JANDY PRO SERIES TRUCLEAR CHLORINE GENERATING SYSTEM

  • Active Ingredient(s)
    • DEVICE, NO GUARANTEE REQUIRED

7. b) Type of formulation.

Other (specify)

DEVICE

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).

We received the complaint from a licensed electrical contractor who had installed this product. The voltage difference between the two water bodies was witnessed and photographed. The contractor explained he has this same problem on two other sites and is in the process of replacing each of the units with a different model which according to him resolves the issue.

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: Unknown

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

  • General
    • Symptom - Other
    • Specify - Electric shock

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)

Contact with treated area

What was the activity? Touching the pool water and spa water at the same time

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

We received the complaint from a licensed electrical contractor who had installed this product and was contacted by the homeowner with a complaint of receiving a shock when touching the pool water and spa water at the same time. Photos were taken during site visit on July, 8 2021. The voltage difference between the two water bodies was witnessed and photographed. The contractor explained he has this same problem on two other sites and is in the process of replacing each of the units with a different model which according to him resolves the issue.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.