Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2053

2. Registrant Information.

Registrant Reference Number: 3870772

Registrant Name (Full Legal Name no abbreviations): 2022 Environmental Science CA Inc.

Address: 137 Glasgow Street, Suite 210, Unit 111

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.

20-MAR-24

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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. 30075      PMRA Submission No.       EPA Registration No.

Product Name: Bedlam Insecticide (non-company)

• Active Ingredient(s)
  • D-PHENOTHRIN
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE

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PMRA Registration No. 27428      PMRA Submission No.       EPA Registration No.

Product Name: Demand CS Insecticide (non-company)

• Active Ingredient(s)
  • LAMBDA-CYHALOTHRIN

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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. - 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

• Reproductive System
  • Symptom - Other
  • Specify - Enlarged ovary

• Respiratory System
  • Symptom - Shortness of breath
  • Symptom - Wheezing
  • Symptom - Difficulty Breathing

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)

Contact with treated area

Amount of time between application and contact 8

Hour(s) / Heure(s)

What was the activity? Reentry into the treated home and cleaning of product residue.

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?

>1 yr / > 1 an

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.)

3/20/2024 All of the following has been spontaneous reported by the caller. The caller is reporting an enlarged ovary since the listed products have been used within her residence. The caller advised that the products have been used within the residence on and off for three years for bed bugs. She advised that when the product is applied within her residence, she would leave for 8 hours. The first time she returned to her home, she experienced an asthma attack with difficulty breathing and wheezing. After the initial use in the home, she would move furniture back to where it belonged and she would experience an asthma attack. At some point, the caller advised that she had to use her inhaler once. She could see the residue of the products on her furniture, inside drawers, closets, any where the product was sprayed. About a month ago, the caller was at her doctors office for a check up when they determined that the right ovary is enlarged, three times the size it should be. The caller has a follow up the afternoon of 20, March 2024 with her doctor. She did not clean the product the first couple times that the product was sprayed but did start wiping it down the last few times it was sprayed. It is unknown if she wore gloves while doing so. No direct therapies have been completed for the enlarged ovary.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

The reported symptoms are best reviewed separately, with two correlation scores. Symptoms: Shortness of breath and wheezing. Company correlation score=5 (Probable relationship). While the consumer reported to have exceeded labeled re-entry recommendations for Temprid SC Insecticide of 6 hours, inhalation of the product residue while moving furniture around may cause respiratory irritation, coughing, and shortness of breath. These symptoms would be expected acutely and to be self-limiting with ventilation. Of note, the consumer has underlying asthma. People with underlying respiratory conditions may experience more pronounced symptoms upon inhalation exposures. Her symptoms appeared to have abated with use of her prescribed inhaler. Of note, two other products were also used in her home during application, Bedlam Insecticide and Demand CS Insecticide. It is unclear how the products were applied and used in her home. Symptom: Enlarged Ovary. Company correlation score= 1 (Unlikely relationship). While a loose temporal relationship exists between the product use in her home with the findings of an enlarged ovary, there are no specific reports of direct exposure to the product. Of note, two other products were also used in her home during application, Bedlam Insecticide and Demand CS Insecticide. It is unclear how the products were applied and used in her home over the period of 3 years. Temprid SC Insecticide is not expected to result in reproductive or organ toxicity to the ovary. All other differential diagnoses have not been ruled out.