Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-0943

2. Registrant Information.

Registrant Reference Number: 15800

Registrant Name (Full Legal Name no abbreviations): Recochem Inc.

Address: 8725 Holgate Crescent

City: Milton

Prov / State: ON

Country: Canada

Postal Code: L9T 5G7

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

Human

4. Date registrant was first informed of the incident.

28-MAY-21

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

22-MAY-21

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. 15800      PMRA Submission No.       EPA Registration No.

Product Name: SOLVABLE WOOD PRESERVATIVE

• Active Ingredient(s)
  • ZINC (PRESENT AS ZINC NAPHTHENATE)

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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).

The customer used the product to stain her fence and deck. The customer used 6 cans of Armorall Mocha Wood Preservative over a period of 2 days.

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.

Other

2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Weakness

• Eye
  • Symptom - Irritated eye

• Nervous and Muscular Systems
  • Symptom - Headache

• Gastrointestinal System
  • Symptom - Vomiting

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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

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.

Respiratory

11. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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 consumer purchased 6 cans of Mocha Brown Wood Preservative product. The consumer purchased the product to stain her fence and deck, but this is not the recommended use of the wood preservative product. The consumer advised that this was recommended by a Rona store employee. The consumer used 6 cans of the wood preservative over a period of two days to stain her fence and deck. The deck is attached to the house, and the customer stated that the smell had permeated the interior of her house. The Fire Department was called by a neighbor to report a strong odor in the area. The Fire Department concluded that the volume the consumer used resulted in the symptoms and strong odour. After use of the product the customer experienced vomiting, weakness, severe headaches, and eye irritation.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

The product comes as a 3.5 L pail. The label is wrapped around the pail with the product name, hazard pictogram located on the front half-side of the pail. The statements "READ THE LABEL BEFORE USING", "NOT FOR USE IN DWELLING" and "NOT A FINAL COAT" is stated on the half-side of the pail. The recommendations for use of the product, precautions, first aid, toxicological information, environmental hazards, notice to users, and disposal and storage are located on the opposite side. The product is NOT to be used as a stain.