Health Canada
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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2055

2. Registrant Information.

Registrant Reference Number: 3830197

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.


4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


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


  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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?


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: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.


  • Gastrointestinal System
    • Symptom - Irritated throat
  • Respiratory System
    • Symptom - Coughing
    • Symptom - Irritated nose
    • Symptom - Respiratory congestion
  • Skin
    • Symptom - Itchy skin
    • Symptom - Rash
  • Respiratory System
    • Symptom - Sore throat
    • Symptom - Other
    • Specify - Sore inside nose

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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

Contact with treated area

Amount of time between application and contact 6

Hour(s) / Heure(s)

What was the activity? Reentry into the treated home.

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


10. Route(s) of exposure.


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.)

1/23/2024 All of the following has been spontaneously reported by the caller. Caller reports nasal congestion, sore throat, sore inside nose, coughing, rash and itching after exposure to the product. Caller states that a Pest Control Company sprayed the product on 01/15/2024. She had left the home for 6 hours and she returned after the 6 hours. The product was dry in the home and they have the windows cracked open. Later in the day her symptoms developed. She started taking Benadryl and over the counter sinus cold and cough medication. Her symptoms persisted and she saw her primary care doctor on 01/19/2024 and was told to either take Benadryl or over counter Sinus Cold and Sinus. Also instructed to call the company to see if her symptoms could be related to product. Her symptoms are persisting and she is going back to her doctor today 01/23/2024. 1/24/2024 Caller did see her doctor again and was given an unspecified nasal ointment to treat the nasal irritation. She is feeling better today. The doctor told her she is likely very sensitive to something in the product. She was also told if her building is treated again she should spent the night elsewhere.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.

Company correlation score: 4 (Possible Relationship). The product had dried after application before the patient returned home and no direct exposures to wet product were reported. While there is a temporal relationship between the consumer returning home after application and the onset of symptoms her symptoms did abate without product removal or clean up. Sensitivities to chemical and products can exist, but all other differential diagnoses have not been definitely ruled out.