Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2024-2439
2. Registrant Information.
Registrant Reference Number: Rocky Mountain PC Case#: 6805338
Registrant Name (Full Legal Name no abbreviations): FMC of Canada Limited
Address: 6755 Mississauga Road, Suite 204
City: Mississauga
Prov / State: ON
Country: Canada
Postal Code: L5N 7Y2
3. Select the appropriate subform(s) for the incident.
Human
4. Date registrant was first informed of the incident.
01-JUN-24
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
31-MAY-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)
PMRA Registration No. 24175
PMRA Submission No.
EPA Registration No. 279-3062
Product Name: Dragnet SFR Termiticide Insecticide
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).
Apartment was sprayed for beetles yesterday. Told safe to return in 6 hrs, her and cat.Came back 9 hrs post application and still looked wet. Cat was not exposed, sent to cat care. Caller was in area. Congestion/runny nose but "99%" sure not related. Still shiny after 24 hrs - concerned to bring the cat home - how to clean up? Pest control company us closed.
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: Female
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Respiratory System
- Symptom - Nasal congestion
- Symptom - Runny nose
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 9
Hour(s) / Heure(s)
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.
Respiratory
11. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
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.)
Caller was in area. Congestion/runny nose but "99%" sure not related.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.
Caller was in area. Congestion/runny nose but "99%" sure not related.