Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2025-0580

2. Registrant Information.

Registrant Reference Number: 353582

Registrant Name (Full Legal Name no abbreviations): Premier Tech Ltd.

Address: 1 avenue Premier

City: Riviere-du-Loup

Prov / State: Quebec

Country: Canada

Postal Code: G5R 6C1

3. Select the appropriate subform(s) for the incident.

Human

Packaging Failure

4. Date registrant was first informed of the incident.

03-OCT-24

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

29-JUL-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. 29426      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Fly Out Flying Insect Killer

• Active Ingredient(s)
  • D-PHENOTHRIN
  • TETRAMETHRIN

---

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: Pub. Area - Indoor/Zone publique - int

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Product was first applied in the garbage room located in the building basement, and then at the 4th floor of the building, in the garbage chute room. The user has opened the garbage chute door and sprayed the flies that were coming out. User reported that he was holding the can slightly tilted sideways to ensure a good grip and prevent can to fall out in the garbage chute.

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: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Bleeding
  • Symptom - Bruises
  • Symptom - Lesion

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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)

Application

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.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

<=30 min / <=30 min

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.)

User purchased 3 aerosol cans of Wilson Fly Out Flying Insect Killer. User has applied 2 cans and approximately a quarter of the third can in the basement (garbage room). Then he went on 4th floor of the building to spray in the garbage chute room. He opened up the garbage chute door and started spraying the flies that were coming out, holding the can slightly tilted sideways. In a matter of seconds, the can exploded while user was handling the product. The explosion propelled sharp pieces of the can, which caused severe lacerations on user hand and fingers (3 deep cuts), and also a large bruise from the bottom of the can hitting user in the side of his stomach. User has received 14 stitches at the hospital emergency, where he stayed for about 4.5 hours.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

User reported that in the store where he has purchased the products, some cans showed signs of damage, as if they had been cut into by a knife. User said that he had spoke to store manager, and that the store conducted a sweep and discarded many damaged products.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Can / Cannette

2. Did packaging failure occur during?

Use of Product

3. Did packaging failure result in?

potential injury

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

User purchased 3 aerosol cans of Wilson Fly Out Flying Insect Killer. User has applied 2 cans and approximately a quarter of the third can in the basement (garbage room). Then he went on 4th floor of the building to spray in the garbage chute room. He opened up the garbage chute door and started spraying the flies that were coming out, holding the can slightly tilted sideways. In a matter of seconds, the can exploded while user was handling the product. The explosion propelled sharp pieces of the can, which caused severe lacerations on user hand and fingers (3 deep cuts), and also a large bruise from the bottom of the can hitting user in the side of his stomach. User has received 14 stitches at the hospital emergency, where he stayed for about 4.5 hours.

For Registrant use only

5. Provide supplemental information here.

User reported that in the store where he has purchased the products, some cans showed signs of damage, as if they had been cut into by a knife. User said that he had spoke to store manager, and that the store conducted a sweep and discarded many damaged products.