Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2022-6528
2. Registrant Information.
Registrant Reference Number: 020829451A
Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited
Address: 1 Webster Street
City: Brantford
Prov / State: ON
Country: Canada
Postal Code: N3T 5R1
3. Select the appropriate subform(s) for the incident.
Packaging Failure
4. Date registrant was first informed of the incident.
25-SEP-22
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. 29776
PMRA Submission No.
EPA Registration No.
Product Name: RAID WASP & HORNET BUG KILLER 7
- Active Ingredient(s)
- D-PHENOTHRIN
- TETRAMETHRIN
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: Unknown / Inconnu
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?
Pressurized product /Prod. sous pression
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.
Customer reported that the product came out like a foam mist type spray only spraying about a meter.
For Registrant use only
5. Provide supplemental information here.
No actual exposure/ injury was reported by the consumer. The information contained in this report is based on self-reported statements provided to the registrant during e-mail communications and/or telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident.