Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-0004

2. Registrant Information.

Registrant Reference Number: 2349047

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

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

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

Environment

4. Date registrant was first informed of the incident.

28-NOV-18

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.

Active(s)

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PMRA Registration No. 29322      PMRA Submission No.       EPA Registration No.

Product Name: Raid Max Home Insect Killer 500g - Canada

• Active Ingredient(s)
  • PIPERONYL BUTOXIDE
  • PYRETHRINS

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Other / Autre

Préciser le type: Indoor plant

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Other/Inv.Ter-Autre

2. Common name(s)

Ladybug

3. Scientific name(s)

Coccinellidae

4. Number of organisms affected

900

5. Description of site where incident was observed

Fresh water

Terrestrial

Residential

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

11/28/2018 Caller estimates that around 10/10/2018 he applied product to a large plant that had been brought inside and was infested with aphids. Only around 30 percent of the aphids were killed, and caller applied product a second time 3 or 4 days later. The caller still saw little effect on the aphids, and applied product a third time about a week after the second application. Around 2 to 3 weeks after the initial application, caller thoroughly washed the plant over the course of 2 days. Caller purchased 1,000 ladybugs hoping they would control the aphids, and applied them to the plant 3 days ago. Caller estimates that up to 900 of the ladybugs are now dead. Caller also placed some of the ladybugs on an herb garden that was not treated with the product, and none of those have been affected. Caller also stated that he treated a poblano pepper plant with the product. He then washed and consumed the peppers. He has remained asymptomatic. Caller also has a dog that sleeps in the same room where the product was used.

8. a) Was the incident a result of (select all that apply)

Application

N/A

8. b) i) How many times has the product been applied this year?

1

8. b) ii) What was the date of the last application?

10-OCT-18

9. Did it rain

9. a) During application?

No

9. b) Up to 3 days after application?

No

10. a) Was there a buffer zone?

No

10. b) What type?

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Minor

13. Please provide supplemental information here