Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-1549

2. Registrant Information.

Registrant Reference Number: X

Registrant Name (Full Legal Name no abbreviations): X

Address: X

City: X

Prov / State: X

Country: X

Postal Code: X

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

Human

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

27-MAR-24

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. 32151      PMRA Submission No.       EPA Registration No.

Product Name: BELL & HOWELL ULTRASONIC RODENT REPELLERS

• Active Ingredient(s)
  • DEVICE, NO GUARANTEE REQUIRED

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7. b) Type of formulation.

Other (specify)

Device

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).

I have a next door neighbor in our residential neighborhood of (city), Ontario who each spring, installs high frequency emitting pest repelling devices in an effort to try to keep squirrels rodents etc off of his lawn. These devices are recognized to annoy some humans and can cause negative health consequences. He recently re-installed the device on Wed. March 27th, 2024. He has been asked in writing to stop operating this device or devices but continues to do so. In fact, he continues to do so contrary to the direction of municipal by law officers who have investigated and attended at his property in the past. I believe that these devices are unsafe for humans and animals alike. Suspected Bell and Howell Ultrasonic pest repellers (subject of a class action lawsuit in New York State) but not certain, homeowner will not disclose details of device.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Ear
  • Symptom - Ringing in ear

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)

Other

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.

Unknown

11. What was the length of exposure?

Unknown / Inconnu

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.)

It has caused constant intense ringing in my ears.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.