Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2063

2. Registrant Information.

Registrant Reference Number: 3830400

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.

23-JAN-24

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

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. 15255      PMRA Submission No.       EPA Registration No.

Product Name: DRIONE INSECTICIDE POWDER

• Active Ingredient(s)
  • PIPERONYL BUTOXIDE
  • PYRETHRINS
  • SILICA AEROGEL

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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?

Unknown

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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Palpitations

• Gastrointestinal System
  • Symptom - Irritated throat
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Dizziness
  • Symptom - Headache

• Respiratory System
  • Symptom - Sore throat

• Gastrointestinal System
  • Symptom - Other
  • Specify - Esophageal irritation

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

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)

None

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

12. Time between exposure and onset of symptoms.

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

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 is calling on behalf of the person that was exposed to DRIONE INSECTICIDE POWDER and is seeking recommendations after experiencing symptoms of headaches, sore throat, esophageal irritation, heart palpitations, nausea, and dizziness. She stated that the person exposed had her apartment fumigated by a pest control company on 1/18/24, and they had used the DRIONE INSECTICIDE POWDER. She believes that the product was over used since there was a large amount of residue left all over the apartment. The apartment was treated for bed bugs and the product was used on the person's bed frame and couches. She believes that the product is only to be used in holes and baseboards, not the way it was used in the person's apartment. The caller stated that this product was in the air and floors and she inhaled a lot of the product. The next morning, the person that was exposed, decided to clean up the product by sweeping. She did not wear gloves when cleaning up. Then, the person began experiencing a sore throat, esophageal irritation, nausea, headaches, dizziness, and heart palpitations, after she cleaned the product. The person decided to get some fresh air 2 days after the exposure and has taken Tylenol for the headaches. The caller stated that she has opened up a few windows in the apartment as well. 1/24/2024 Attempted callback. Left a detailed message requesting a callback. Case and callback numbers provided.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Company correlation score: 4 (Possible Relationship). The product contains pyrethrins 1%, piperonyl butoxide 10% and silica 40% and is directed to be applied to cracks and crevices, dusted in joints, channels, and mattresses of beds to treat for bed bugs. In this case, the caller reported the product residue was found aall overa the apartment including in the air, allowing for potential inhalation of the product. The consumer attempted to clean up the residue, without personal protective equipment, by sweeping which can also result in kicking up the dust allowing for further inhalation. Inhalation of the product can result in throat irritation and possibly headaches as reported by the consumer however palpitations, dizziness, and nausea would not be expected. Given her reported ongoing palpitations and dizziness it was recommended she seek medical evaluation to consider other possible differential diagnoses. Further follow up was attempted but unable to be obtained. Re-challenge