Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2013-6143

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR case: 1-35057268

Nom du titulaire (nom légal complet, aucune abbréviation): Scotts Canada Ltd.

Adresse: 2000 Argentia Road, Plaza 5, Suite 101

Ville: Mississauga

État: Ontario

Pays: Canada

Code postal /Zip: L5N2R7

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez l'humain

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

25-SEP-13

5. Lieu de l'incident.

Pays: CANADA

État: QUEBEC

6. Date de la première observation de l'incident.

21-SEP-13

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

---

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. Inconnu

Nom du produit: Unknown

• Matière active
  • CHLORPYRIFOS

---

7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Pub. Area - Indoor/Zone publique - int

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Non

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Applied in workplace. Worker was sitting at his or her desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Inconnu

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Sitting at desk

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Applied in workplace. Worker sitting in their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace was treated. Sitting in their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace was treated. The worker was sitting in their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Applied in workplace. Worker was sitting at their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Applied in a workplace. Worker was sitting at their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Irritation de la peau
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace was treated. Worker was sitting at their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace treated. Worker was sitting in their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace treated. Worker sitting at their desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: Unknown / Inconnu

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Sitting in his or her office chair

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? The patient was sitting in his or her office desk.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Sitting at office work space

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting work area where product had recently been applied

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Workplace was treated with the product. Worker sitting at their work station.

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in her workplace

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Inconnu

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Inconnu

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Systèmes nerveux et musculaire
  • Symptôme - Mal de tête
  • Symptôme - Étourdissement

• Peau
  • Symptôme - Prurit
  • Symptôme - Éruption cutanée

• Système respiratoire
  • Symptôme - Respiration faible

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Employee sitting in work area

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Autre

2. Renseignement démographique sur la personne affectée

Sexe: Inconnu

Âge: >19 <=64 yrs / >19 <=64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

• Oeil
  • Symptôme - Yeux enflés
  • Symptôme - Irritation de l'oeil

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Non

6. a) Est-ce que la personne a été hospitalisée?

Non

6. b) Pendant combien de temps?

7. Scénario d'exposition

Professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Contact avec la zone traitée

Quelle était l'activité? Sitting at work space

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

Respiratoire

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-35057268 - The reporter, an employee of the (name), indicated that workers at a call center were exposed to an insecticidal product containing the active ingredient pyrethrins. The reporter indicated that the pest control operator (PCO) who applied the product at the call center was reluctant to provide any product information. He only provided a partial name of the product Ecosense Bug-B-Gon and he stated that the active ingredient was permethrin. He also indicated that he diluted the product prior to use. The PCO would not provide any additional product information and therefore the reporter could not provide the PCP registration number for the product nor could she provide the UPC number. Based on the information provided our best guess as to the product used by the PCO is the Ecosense Bug-B-Gon Concentrate with the active ingredient pyrethrins. Per the reporter the PCO applied the product during the night (Saturday 9/21/13) to the carpet, chairs and fabric cubicle dividers in the call center. Employees were present during product application and sat on chairs while they were still wet from the product. The following day which was Sunday (9/22) 18 people were working in the call center and some (Subform II #11) complained of headaches. On Monday (9/23), thirty-five people worked in the call center. None of the people who had worked in the call center on Sunday (9/22) worked in the call center on Monday (9/23). Of the 35 people who worked on Monday, 10-15 of the workers (Subform II #1-10), left work that day due to headaches, dizziness, itchy skin with a rash and shortness of breath. On Wednesday September 25th (three days after product application) the same thing happened, 10-15 of the 39 workers (Subform #12-22) who worked at the call center that day had to leave work due to headaches, dizziness, itchy skin with a rash and shortness of breath. The reporter also stated that she went to the site on Tuesday, September 24th (the day of initial contact with the registrant) and noted that some workers also had swollen and inflamed eyes (Subform II #23). It was not indicated if the same people who worked in the call center on Monday (9/22) were the same people who worked on Tuesday (9/23) and it was not indicated if the same people who had symptoms on Monday were the same people who had symptoms on Tuesday. Therefore the number of people who developed symptoms on Monday and Tuesday could be between 10-30 people. Per package labeling this product is meant to be used on plants, bushes and trees. Use in an office on carpets, chairs and soft fabrics is not recommended and ventilation and cleaning of the site was advised. The reporter indicated that ventilation of the site was difficult as the call center is housed in a mall where there are no windows and no direct outlets to fresh air. At the time of the initial call, the call center had opened the one door that lead into the business and they were using fans to help remove fumes. On follow-up call, five days later, an employee at the call center stated that the center was closed and cleaned and all symptoms resolved without need for medical intervention. No further information is available.

À être déterminé par le titulaire

14. Classification selon la gravité.

Mineure

15. Donner des renseignements additionnels ici.