Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2025-0991

2. Registrant Information.

Registrant Reference Number: 4000096

Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

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

Human

Packaging Failure

4. Date registrant was first informed of the incident.

04-OCT-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. 30154      PMRA Submission No.       EPA Registration No.

Product Name: OFF! FamilyCare Aerosol with Picaridin, 142g [Canada]

• Active Ingredient(s)
  • ICARIDIN

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PMRA Registration No. 33575      PMRA Submission No.       EPA Registration No.

Product Name: OFF! Deep Woods - DEET Free, 142g (aero) [Canada]

• Active Ingredient(s)
  • ICARIDIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

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: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• General
  • Symptom - Other
  • Specify - Unspecified symptoms

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)

What was the activity? Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding the activity

Other

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

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.)

10/4/2024 Customer Service representative called in to report dermal exposure on behalf of the consumer after using the products. She stated the consumer said the products were malfunctioning and did not dispense at first. Once the product did dispense she got some on her hand. She reports she went to the emergency room and received some antibiotics for treatment. Customer Service representative stated the consumer declined transfer to medical team, because she is doing better now. No further details provided.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.

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

potential exposure

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

10/4/2024 Customer Service representative called in to report dermal exposure on behalf of the consumer after using the products. She stated the consumer said the products were malfunctioning and did not dispense at first. Once the product did dispense she got some on her hand. She reports she went to the emergency room and received some antibiotics for treatment. Customer Service representative stated the consumer declined transfer to medical team, because she is doing better now. No further details provided.

For Registrant use only

5. Provide supplemental information here.

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.