CHNN11 battery exposures

INCIDENT INVESTIGATION ASSIGNMENT INSTRUCTIONS
Battery Exposures
DOCUMENT NUMBER:
DATE OF INCIDENT:

CATID: CHNN11 2020

FOLLOW-UP REQUESTED

HAZARD ANALYSIS

COMPLIANCE

PRIMARY CONTACT: Cheryl Scorpio, HS, 301-987-2572, [email protected]
BACK-UP CONTACT: Angie Qin, EPHA, 301-504-7810, [email protected]
ASSIGNMENT MESSAGE:

Determine if the respondent is the victim, is the parent of an injured child under 18, or is involved in
another capacity (specify). Determine if the respondent witnessed the incident. Describe the incident
scenario, any subsequent treatment, and the resolution of the injury (recovered fully, partial recovery,
etc.). If fatal, life-threatening, or resulting in permanent disability, collect all official documentation.
Determine the brand name and size, and model of the battery, including the voltage and any markings on
the battery itself. Did the battery package or battery have any warning markings on it. Was the original
packaging of the battery child-resistant?
Determine the product the battery came from, such as a toy, a remote control, calculator, or other
electronic device. If the product is a toy, the date of purchase of the toy is especially important.
Describe the battery compartment, and ask whether the compartment would be easy for a young child to
open. Did the battery compartment have screws or other securing mechanisms?
Complete the battery exposure questionnaire (found below, or contact Cheryl Scorpio, 301-987-2572, for
a copy).
Please include all primary and all backup contacts in the distribution of the completed IDI.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Area below will be completed in Data Systems _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Person(s) to Contact:
Guidelines:
Task Number:
Assigned to:

CPSC FORM 324A

Date:
Processed by: lew

Task Number:_____________________________________

Exhibit Number________________

Battery Exposures Questionnaire
(updated 10/01/2018)

Q.1 General Instructions - Battery Exposures:
Most incidents will involve battery ingestion by a child, which resulted in the child's hospitalization. The
respondent will generally be the child's parent or guardian.
Bold type indicates what should be said to the respondent. Instructions for the interviewer will be
prefaced by “Interviewer:” and are written in non-bold type. Please do not read choices or give examples
unless explicitly instructed to do so for a particular question. Also, if the respondent is unsure, then you
can prompt. Do not read the “Refused” or “Unknown” choices.
Q.2 Interviewer: Complete before dialing.
Enter task number (13 characters).
__________________________

Q.3 Interviewer: Complete before dialing.
Enter Incident Date, to be used in introduction (Ex: October 10, 2013):
__________________________________________________

Q.4 Hello, may I speak with a parent or guardian of [victim/child's name] ?
Interviewer: If a parent or guardian is not available, please ask for a convenient time to call back.
Q.5 Hello, I am calling on behalf of the U.S. Consumer Product Safety Commission. We are trying to
learn more about battery exposure injuries in children to prevent similar incidents from occurring
in the future.
I would like to ask you some questions about the recent incident on [ANSWER TO Q.3], which
involved [child's first name]’s exposure to a battery.
The interview should take about 10 minutes. All answers will be kept confidential and no names will
be associated with the answers. The information collected will be used only to prevent future
incidents and injuries. Your participation is voluntary.
Q.6 Are you familiar with the battery exposure incident that I just mentioned?
[Interviewer: If the parent or guardian is not familiar with the incident, ask to speak to an adult who IS
familiar with the incident.]
1
2
3
4
CPSC FORM 324A

Yes - Continue interview
No - Call different respondent
Incident did not involve a battery, specify other product
Refused – skip to Q.81 – Thank you for your time.

Q.7 If the incident did not involve a battery, please clarify what the product was.
__________________________________________________________________________________________

[Interviewer: If a battery was not involved, then skip to Q.76 - “Due to the cultural diversity in the U.S…”]
Q.8 What is your relationship to the child involved in the incident?
 1 Parent or Guardian
 2 Other

Q.9 Specify other relationship to the child
__________________________________________________

Q.10 What was the child’s age at the time of the incident?
__________________________________________________

Q.11 Did you witness the child coming into contact with the battery?
[Interviewer: For example, did the respondent see the child put the battery in his/her mouth or ear or
nose?]
 1 Yes
 2 No

Q.12 Indicate if battery ingestion, or insertion into the ear or nose.
 1 Ingestion
 2 Insertion into ear or nose

Q.13 Did you witness the child showing symptoms from the battery exposure?
 1 Yes
 2 No

Q.14 As background information on the child, could you tell me if he/she had any developmental issues
before this incident, either mental or physical?
1
2
3
4

Yes
No
Unknown
Refuse to Answer

Q.15 If so, please describe the issue(s).
__________________________________________________________________________________________

CPSC FORM 324A

Q.16 Please describe the incident, starting with what the child was doing just before he/she came into
contact with the battery, until the time he/she went to the emergency room.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Thank you. Now I'd like to go over some details about how the child came into contact with the battery.
Q.17 How many batteries were ingested or inserted in nose or ear? List number or state unknown: ______
Q.18 Before the incident occurred, was the battery housed in another product?
[Interviewer: Examples would be a toy, remote control, battery charging device, etc.]
 1 Yes – skip to Q.26 – What product was battery in?
 2 No
 3 Unknown

Q.19 Before the incident occurred, was the battery in its original packaging?
 1 Yes
 2 No – skip to Q.41 – Please tell me anything you know about where the battery was located…
 3 Unknown – skip to Q.41 – Please tell me anything you know about where the battery was located…

Q.20 Were there any warnings on the battery packaging?
 1 Yes
 2 No
 3 Unknown

Q.21 Had the battery packaging been opened prior to this incident?
 1 Yes
 2 No
 3 Unknown

Q.22 Was the battery packaging child resistant?
 1 Yes
 2 No
 3 Unknown

Q.23 Were scissors or a tool required to open the packaging?
 1 Yes
 2 No
 3 Unknown
CPSC FORM 324A

Q.24 Were there multiple batteries in the package?
 1 Yes
 2 No
 3 Unknown

Q.25 If so, did the other batteries have safety tabs or stickers attached to them?
 1 Yes
 2 No
 3 Unknown

Q.26 What product was the battery in? [Interviewer: Only one choice may be selected.]
Determine if the battery came from a toy, remote control, calculator, or other electronic device. If the product was a toy, ask if
they know the date of purchase. If the toy packaging or instructions are available, were there warnings for coin cells on the
packaging or in the product instructions.
 01 Hearing Aid
 02 Jewelry (incl. “play” jewelry)
 03 Remote control device
 04 Watch
 05 Calculator
 06 Portable light (flashlight, booklight, laser pointer, etc.)
 07 Clock
 08 Game
 09 Toy
 10 Camera
 11 Greeting card
 12 Book
 13 Thermometer
 14 Other
 15 Unknown

Q.27 Specify “Toy” ___________________________________________________________________________________
Q.28 Specify “Other” product ________________________________________________________________________
Q.29 About how old was the product when the incident occurred?
____________________________________________________________

Q.30 For this product, is a tool (or coin) required to open the battery compartment?
 1 Yes
 2 No
 3 Unknown

Q.31 How does the battery compartment open?
 1 One or more screws must be loosened
 2 Unscrew a component to open (e.g., flashlights, penlights)
 3 Must perform two independent and simultaneous motions (e.g., press tab with finger and slide door open;
push and turn a product component)

 4 Other
 5 Unknown

CPSC FORM 324A

Q.32 Specify “Other” way to open the battery compartment
__________________________________________________________________________________________

Q.33 Was the product broken at any time before the child was exposed to the battery?
 1 Yes
 2 No
 3 Unknown

Q.34 Was the product repaired before the child was exposed to the battery?
 1 Yes
 2 No
 3 Unknown

Q.35 Please describe how the product was repaired.
__________________________________________________________________________________________

Q.36 Just before the incident occurred, was the battery compartment intentionally left open? For
example, someone may have been in the middle of replacing the batteries in the product.
 1 Yes
 2 No
 3 Unknown

Q.37 Is there anything else about the product that you would like to mention?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.38 Who separated the battery from the product?
1
2
3
4
5

The child him/herself
Another child
An adult
Other
Unknown

Q.39 Specify “Other” individual who separated the battery from the product, or describe how the
battery became separated from the product.
__________________________________________________________________________________________

Q.40 If another child separated the battery from the product, was the child older, younger or the same
age as the child who was exposed to the battery?
1
2
3
4
CPSC FORM 324A

Older than victim
Younger than victim
Same age as victim
Unknown

Q.41 Please tell me anything you know about where the battery was located right before the child's
exposure:
__________________________________________________________________________________________

Q.42 Did the battery involved in the incident have a safety tab, with a warning or icon, that was removed
prior to incident?
 1 Yes
 2 No
 3 Unknown

Q.43 Which of the following scenarios best describes the child's battery exposure?
[Interviewer: First read the entire list through “Other”, then have the respondent choose one.]
1
2
3
4
5
6

Child put battery in his/her mouth but did not swallow battery
Child swallowed battery
Child choked on battery (airway was at least partially blocked)
Child placed battery in his/her nose, ear or other body part besides mouth
Other
Unknown

Q.44 Specify “Other” hazard scenario of the battery exposure.
__________________________________________________________________________________________

Q.45 Did the battery leak at any time during the child's exposure?
[Interviewer: For example, battery may have leaked during mouthing of battery or after ingestion.]
 1 Yes
 2 No
 3 Unknown

Q.46 If so, how was it determined that the battery leaked?
1
2
3
4

Told by medical staff / was documented in medical record
I observed it
Someone else observed it
Other

Q.47 Specify “Other” way that it was determined that the battery leaked.
__________________________________________________________________________________________

Q.48 If you observed the leakage and the battery was in the child’s mouth, how did you distinguish the
battery fluid from the child’s saliva?
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.49 Was there evidence of corrosion of the battery?
 1 Yes
 2 No
 3 Unknown
CPSC FORM 324A

Q.50 If yes, please describe the corrosion.
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.51 At this point, I'd like to get some detailed information from you about the battery. So if you need
to step away for a moment to find the battery, or a battery similar to the one involved in the incident, I
can give you a minute to do that. Otherwise, I will need to rely on your memory.
[Interviewer: Choose a response below, depending on whether the respondent retrieves the battery]
Did the respondent retrieve a battery for direct reference?
 1 Yes
 2 No

Q.52 Was the battery a rechargeable type?
 1 Yes
 2 No
 3 Unknown

Q.53 What size was the battery?
[Interviewer: Please read the list of battery sizes through “Other”, then ask the respondent to select one.
If respondent is uncertain about the difference between a “button” or “coin” size battery, please refer to
the photo provided and offer the following descriptions:
Button battery: squat cylinder shape, smaller than a nickel, LESS than a half-inch/1 cm wide
Coin battery (e.g., nickel size): flat round disc-shape, size of a nickel or wider, MORE than a half-inch or
1 cm wide
 01
 02
 03
 04
 05
 06
 07
 08
 09
 10

Button (less than a half-inch/1 cm wide)
Coin (half-inch/1 cm wide or more)
AA (double “A”)
AAA (triple “A”)
AAAA (quadruple “A”)
C
D
9-volt (rectangular)
Other
Unknown

Q.54 Specify “Other” battery size.
________________________________________________________________________________

Q.55 What was the voltage of the battery?
[Interviewer: This information is typically found on the battery, ending in “V”.]
______________________________
CPSC FORM 324A

Q.56 What was the battery manufacturer or brand name?
[Interviewer: This information is typically found on the battery.]
__________________________________________________________________________________________

Q.57 What was the model name and number of the battery?
[Interviewer: This information is typically found on the battery. On button or coin batteries, the
information is located on the positive (+) terminal of the battery. Do not read the following examples
unless asked:
CR 2032: lithium
CR 2016: lithium
SR516: silver
LR44 or AG13: alkaline
__________________________________________________________________________________________

Q.58 What material or mate-+m (Li)
3
4
5
6
7
8
9

Silver oxide (Ag2O)
Zinc (Z)
Manganese dioxide (MnO2)
Nickel (Ni)
Cadmium (Cd / Cad)
Other
Unknown

Q.59 Specify any “Other” material in the battery.
________________________________________

Thank you for your patience. My final set of questions is about the child's symptoms and any medical
treatment received for the battery exposure.
Q.60 During the incident, did the child have any of the following symptoms?
[Interviewer: Read each choice (excl. “Unknown”). Mark all responses that apply.]
 01
 02
 03
 04
 05
 06
 07
 08
 09
 10
 11
 12

CPSC FORM 324A

Vomiting
Drooling
Difficulty swallowing / gagging
Wheezing / difficulty breathing
Choking
Coughing
Loss of appetite / refusal to eat
Lethargy/Loss of energy
Chest discomfort
Burns, internal or external
Other
Unknown

Q.61 Specify any “Other” symptoms.
__________________________________________________________________________________________

Q.62 Please describe any medical treatment the child received at the emergency room and any additional
treatment he/she received for the battery exposure.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.63 Did the child have an x-ray?
 1 Yes
 2 No
 3 Unknown

Q.64 Was the battery found by the x-ray?
 1 Yes
 2 No
 3 Unknown

Q.65 In what area of the child's body was the battery found?
1
2
3
4
5

Esophagus/Throat (i.e., the tube that connects the mouth with the stomach)
Stomach (not including the intestines)
Intestines (includes small and large, “colon”, etc.)
Other
Unknown

Q.66 Specify “Other” area of the child's body where the battery was found.
__________________________________________________________________________________________

Q.67 Was the child admitted to a hospital?
 1 Yes
 2 No
 3 Unknown

Q.68 What was the reason given for the hospitalization?
__________________________________________________________________________________________
__________________________________________________________________________________________
CPSC FORM 324A

Q.69 How many nights was the child hospitalized? If there were multiple hospitalizations, please include
the total number of nights the child stayed in a hospital.
[Interviewer: Write down the answer in whatever unit of time the respondent uses, e.g., “2 nights”, “3
months”, “2 weeks”]
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.70 Was the child ever sent home from the ER or a hospitalization while he/she was still in contact with
the battery?
[Interviewer: For example, child may have been sent home to wait for an ingested battery to pass on its
own.]
 1 Yes
 2 No
 3 Unknown

Q.71 How much time passed between when child was first exposed to the battery and when the exposure
ended?
[Interviewer: For example, in the case of ingestion, the battery may have naturally passed or been
surgically removed. Write down the respondent's answer using the time units they give.]
__________________________________________________________________________________________

Q.72 Did the child experience any of the following complications from the battery exposure?
[Interviewer: Read each choice excl. “No complications” and “Unknown”, then check it if it applies.
Check all that apply. As you enter each number corresponding to a response, the font will change,
showing that the response was selected. ]
1
2
3
4
5
6
7

Bleeding/Hemorrhaging
Damage to the esophagus (ulceration, perforation, etc.)
Pneumonia
Paralysis of vocal cords
Other
No complications
Unknown

Q.73 Specify any “Other” complications.
__________________________________________________________________________________________

Q.74 How were the complications treated?
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.75 Would you be willing to provide a copy of the medical report to us?
[Interviewer: If yes, provide your contact information to the respondent so that he or she can provide
you with the documentation for inclusion in the IDI report. Remind them that their information will
remain confidential.]

Thank you again for your patience. We are almost finished.
CPSC FORM 324A

Q.76 Due to the cultural diversity in the U.S., we sometimes have difficulty communicating important
product safety information to consumers. The following race and ethnicity questions will help us to
better educate the public on consumer product safety.
Do you consider the child in this incident to be Hispanic or Latino?
1
2
3
4

Yes
No
Unknown
Refuse to answer

Q.77 What race or races do you consider the patient to be?
[Interviewer: Please read race choices aloud and ask respondent to select ALL categories that apply.]
The “Other” response may be selected by itself or in addition to the pre-defined race categories.
If the respondent only states “biracial” or “multiracial,” please prompt for specifics (country of origin,
nationality, etc.). Otherwise, simply check “Other” and record “biracial” or “multiracial” as the answer to
the next question (Specify “Other race”).]
1
2
3
4
5
6
7
8

White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other
Unknown
Refuse to answer

Q.78 Specify any “Other” race(s) of the child
__________________________________________________________________________________________

Q.79 Is there anything else you would like to add regarding this incident?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.80 On behalf of the Consumer Product Safety Commission, I thank you very much for your help. If I
missed anything, may I call you back at this number?
[Interviewer: If the respondent prefers you to call back at another number, record it on the Record of
Call sheet.]
 1 Yes
 2 No

Q.81 Thank you for your time.

CPSC FORM 324A