Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2022-6536
2. Registrant Information.
Registrant Reference Number: 3340507
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.
29-JUL-22
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
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. 30744
PMRA Submission No.
EPA Registration No.
Product Name: RAID Outdoor Ant Nest Destroyer 2, 400g [Canada]
- 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: 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).
Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
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.
7/29/2022 Caller reports that the container started to leak at the nozzle and the product got onto his hand. Caller was able to wash his hands and did not have a reaction to the product. The caller did not state when this happened.
For Registrant use only
5. Provide supplemental information here.
The information contained in this report is based on self-reported statements provided to the registrant during 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. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.