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)

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PMRA Registration No. 24175      PMRA Submission No.       EPA Registration No. 279-3062

Product Name: Dragnet SFR Termiticide Insecticide

• Active Ingredient(s)
  • PERMETHRIN

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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. - 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.