Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-5453

2. Registrant Information.

Registrant Reference Number: 3658346

Registrant Name (Full Legal Name no abbreviations): 2022 ENVIRONMENTAL SCIENCE CA INC.

Address: 210-137 GLASGOW STREET

City: KITCHENER

Prov / State: ON

Country: CANADA

Postal Code: N2G 4X8

3. Select the appropriate subform(s) for the incident.

Human

4. Date registrant was first informed of the incident.

12-JUL-23

5. Location of incident.

Country: UNITED STATES

Prov / State: ARIZONA

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.       PMRA Submission No.       EPA Registration No. 432-1544

Product Name: Temprid FX Insecticide (EQUIVALENT TO TEMPRID SC in CANADA)

• Active Ingredient(s)
  • BETA-CYFLUTHRIN
  • IMIDACLOPRID
    • Unknown

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Gentrol (non-company)

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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).

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?

No

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Female

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Nausea
  • Symptom - Vomiting

• General
  • Symptom - Diaphoresis
  • Symptom - Other
  • Specify - Brain fog

• Gastrointestinal System
  • Symptom - Other
  • Specify - Film in mouth

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Anxiety

• Renal System
  • Symptom - Polyuria

• Respiratory System
  • Symptom - Coughing
  • Symptom - Respiratory congestion

• Skin
  • Symptom - Blister
  • Symptom - Hives
  • Symptom - Other
  • Specify - Painful nodules to deep touch

• Respiratory System
  • Symptom - Nose bleed
  • Symptom - Other
  • Specify - Film in nose

• Nervous and Muscular Systems
  • Symptom - Numbness
  • Specify - Numb to light touch

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Application

Contact with treated area

What was the activity? The patient remained in the apartment during treatment.

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

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

>1 yr / > 1 an

12. Time between exposure and onset of symptoms.

>6 mos / > 6 mois

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.)

All the following were caller stated: Since 2018 applications recurred every 3 month, in instances sprayed right around her bed while she remained in apartment.PCO changed OCT'18 to another PCO. After 1 year, both started getting anxiety attacks, outbursts. NOV'22, during treatment, hair brush was on counter close totreatment area and she believes it caused development of fluid filled blisters on scalp in DEC'22. Emergency dept. made no diagnosis, told to wash with mildsoap and prescribed antibiotics, but still spread to forehead by JAN'23. Was not followed up to dermatologist, but blisters and fluid filled resolved to leave noduleswhich are painful to deep touch. Latest MAY 25,'23 application, both remained in apart. during appl., not advised to vacate, product was broadcast sprayed, inappl. to bathroom product got on shower curtains and toothbrush. Product got all over mattress, nightstand, dresser, bed frame, clothing and paper etc. aroundroom. PCO did not mention 3 hour non-touch period, done before. She told him to stop and operator left. Both exited, returned few hours later. Upon re-entry -both noted strong odor, opened window and door to ventilate, developed strong headache, felt brain fog, followed by vomiting, development of congestion andcough. Both also had bloody nose and diarrhea. Symptoms persisted and called apprt. manager about concern, was advised to talk to PCO, who denied misuseof product and gave products used in MAY '23. Caller cleaned, with gloves, long sleeves(got wet during). Both developed various symptoms incl. blisters andhives after -caller on arms, necks, buttocks, hands, face; Son's arms, legs, back, buttocks - probably from sitting on couch, treated toilet seat, though no directcontact specified earlier. Treatment with Mg and Benadryl helped, public nurse came but just advised drinking water not touch blisters. She moved approx. JUN7, '23 temporarily, all symptoms since resolved excl. ocassional nausea.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The product at directed dilution contains less than 0.1% Imidacloprid and less than 0.05% Beta-cyfluthrin depending on chosen dilution rate. The reporter stated product was applied every 3 months before the last application. Applications before also broke label, but one on May 25, 2023 used a 'space spray' application according to the reporter to have occurred, even in bathroom. No direct exposures to wet product was reported at any time. They were told to not touch areas of application for three hours after application and on May 25, 2023, they left the home after application (not asked by PCO) for a few hours. During previous applications, product was applied as a spot treatment and to crack and crevices and is expected to stay where applied, decreasing the chance for exposure to the product. Additionally, once dried, the active ingredients in the product are not expected to transfer from touch or be inhaled. While the reported signs and symptoms have a temporal relationship to the start of product use all other differential diagnoses have not been ruled out and are not consistent with the described exposure to the product. Of note, the reporter has a past medical history significant for COPD, fibromyalgia, arthritis, degenerative disc disease,chronic daily migraines and is a half a pack per day smoker for which she takes albuterol, ondansetron, and nortriptyline. Removal of the product from application areas did not improve symptoms. Additionally, symptoms improved while reporter was no longer living at the residence, but the nausea remained. True re-challenge,complete removal from the product and resolution of symptoms before re-challenging the product, has not occurred. It is unlikely that the reported signs and symptoms are associated with product use.

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

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

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Nausea
  • Symptom - Vomiting

• General
  • Symptom - Diaphoresis
  • Symptom - Other
  • Specify - Brain fog

• Gastrointestinal System
  • Symptom - Other
  • Specify - Film in mouth

• Nervous and Muscular Systems
  • Symptom - Headache
  • Symptom - Anxiety

• Renal System
  • Symptom - Polyuria

• Respiratory System
  • Symptom - Coughing
  • Symptom - Nose bleed
  • Symptom - Respiratory congestion

• Skin
  • Symptom - Hives

• Respiratory System
  • Symptom - Other
  • Specify - Film in nose

• Skin
  • Symptom - Blister

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

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

Application

Contact with treated area

What was the activity? The patient remained in the apartment during treatment.

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

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

>1 yr / > 1 an

12. Time between exposure and onset of symptoms.

>6 mos / > 6 mois

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.)

All the following were caller stated: Since 2018 applications recurred every 3 month, in instances sprayed right around her bed while she remained in apartment. PCO changed OCT'18 to another PCO. After 1 year, both started getting anxiety attacks, outbursts. NOV'22, during treatment, hair brush was on counter close to treatment area and she believes it caused development of fluid filled blisters on scalp in DEC'22. Emergency dept. made no diagnosis, told to wash with mild soap and prescribed antibiotics, but still spread to forehead by JAN'23. Was not followed up to dermatologist, but blisters and fluid filled resolved to leave nodules which are painful to deep touch. Latest MAY 25,'23 application, both remained in apart. during appl., not advised to vacate, product was broadcast sprayed, in appl. to bathroom product got on shower curtains and toothbrush. Product got all over mattress, nightstand, dresser, bed frame, clothing and paper etc. around room. PCO did not mention 3 hour non-touch period, done before. She told him to stop and operator left. Both exited, returned few hours later. Upon re-entry -both noted strong odor, opened window and door to ventilate, developed strong headache, felt brain fog, followed by vomiting, development of congestion and cough. Both also had bloody nose and diarrhea. Symptoms persisted and called apprt. manager about concern, was advised to talk to PCO, who denied misuse of product and gave products used in MAY '23. Caller cleaned, with gloves, long sleeves(got wet during). Both developed various symptoms incl. blisters and hives after -caller on arms, necks, buttocks, hands, face; Son's arms, legs, back, buttocks - probably from sitting on couch, treated toilet seat, though no direct contact specified earlier. Treatment with Mg and Benadryl helped, public nurse came but just advised drinking water not touch blisters. She moved approx. JUN7, '23 temporarily, all symptoms since resolved excl. ocassional nausea.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.

The product at directed dilution contains less than 0.1% Imidacloprid and less than 0.05% Beta-cyfluthrin depending on chosen dilution rate. The reporter stated product was applied every 3 months before the last application. Applications before also broke label, but one on May 25, 2023 used a 'space spray' application according to the reporter to have occurred, even in bathroom. No direct exposures to wet product was reported at any time. They were told to not touch areas of application for three hours after application and on May 25, 2023, they left the home after application (not asked by PCO) for a few hours. During previous applications, product was applied as a spot treatment and to crack and crevices and is expected to stay where applied, decreasing the chance for exposure tothe product. Additionally, once dried, the active ingredients in the product are not expected to transfer from touch or be inhaled. While the reported signs and symptoms have a temporal relationship to the start of product use all other differential diagnoses have not been ruled out and are not consistent with the described exposure to the product. Of note, the reporter has a past medical history significant for COPD, fibromyalgia, arthritis, degenerative disc disease,chronic daily migraines and is a half a pack per day smoker for which she takes albuterol, ondansetron, and nortriptyline. Removal of the product from application areas did not improve symptoms. Additionally, symptoms improved while reporter was no longer living at the residence, but the nausea remained. True re-challenge,complete removal from the product and resolution of symptoms before re-challenging the product, has not occurred. It is unlikely that the reported signs and symptoms are associated with product use.