Health Canada
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Consumer Product Safety
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-4965
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Prov / State: x
Country: x
Postal Code: X
3. Select the appropriate subform(s) for the incident.
Environment
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
17-SEP-20Product Description
7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.
Active(s)PMRA Registration No. PMRA Submission No. EPA Registration No.
Product Name: Dragnet ft emulsifiable concentrate
- Active Ingredient(s)
- PERMETHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
A technician working who was hired by my neighbour, walked the common perimeter on the neighbour's property. The technician aimed the nozzle of a back pack mistblower into the property line, which sprayed the insecticde directly at my property and me. The technician did the application during a windy day, with gusts of 30 kph and white caps on the lake. My property is over 600 feet long and the wind carried the spray treating that distance into my direction, compounding the exposure.The chipmunk referred to in the symptoms description has it's den in the wooded area that was directly sprayed. I was standing 15' from the property line and I still experienced the spray. The wooded area on my property is ~600' x 15'.To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Mammal-Small/Mammifère-De petite taille
2. Common name(s)
Chipmunk
3. Scientific name(s)
Tamias
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Residential
Salt Water
6. Check all symptoms that apply
Abnormal behavioural effects
7. Describe symptoms and outcome (died, recovered, etc.).
The chipmunk seemed agitated. Fur was missing surrounding the right eye and swelling of the lower eyelid.
8. a) Was the incident a result of (select all that apply)
Unknown
8. b) i) How many times has the product been applied this year?
Unknown
8. b) ii) What was the date of the last application?
Unknown
9. Did it rain
9. a) During application?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
