Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-7198

2. Registrant Information.

Registrant Reference Number: 3764870

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.

07-NOV-23

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

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)

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PMRA Registration No. 32524      PMRA Submission No.       EPA Registration No.

Product Name: Temprid SC Insecticide

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

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

Product Name: Gentrol (non-company)

• Active Ingredient(s)

---

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. - 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).

The safety report states that the product was sprayed at the housing complex. There is no additional information provided on the 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 - Drowsiness
  • Symptom - Malaise

• Nervous and Muscular Systems
  • Symptom - Dizziness
  • Specify - Vertigo
  • Symptom - Muscle trembling
  • Symptom - Shakiness
  • Symptom - Confusion

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)

Contact with treated area

Amount of time between application and contact 2

Hour(s) / Heure(s)

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.

Unknown

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

12. Time between exposure and onset of symptoms.

>30 min <=2 hrs / >30 min <=2 h

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.)

The caller reported the patient stays in a housing complex. The complex was sprayed with a product earlier. She believes that she and her friend may have gone back into the home too soon. They went into the home approximately 2 hours after it was treated for cockroaches. The caller denies having any direct exposure to the product. The caller immediately developed above listed symptoms upon entering the home. She entered the home approximately 45 minutes prior to calling. The caller left the treated residence and went home prior to calling medical. Someone told her fresh air will help. At the time of calling she is drinking ice water and getting fresh air. The caller reported she is still experiencing symptoms at this time. The caller was advised to seek medical treatment, however at the time of the follow-up call, the caller did not seek medical treatment.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

A follow-up call was placed to consumer. She reports that she has had no change in her symptoms and is still feeling very unwell. She did not go to the ER as advised and when asked why, she stated that she just didn't want to go. When asked if she could reach out to her PCP for a visit or even telehealth, she stated "no, they charge too much right now". She stated that she was getting fresh air and drinking water. It is unlikely that the reported signs and symptoms are associated with product use.