Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6609

2. Registrant Information.

Registrant Reference Number: 5099636

Registrant Name (Full Legal Name no abbreviations): Sure-Gro Inc.

Address: 150 Savannah Oaks Dr.

City: Brantford

Prov / State: Ontario

Country: Canada

Postal Code: N3V 1E7

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

Domestic Animal

4. Date registrant was first informed of the incident.

07-JUN-13

5. Location of incident.

Country: CANADA

Prov / State: SASKATCHEWAN

6. Date incident was first observed.

31-MAY-13

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)

---

PMRA Registration No. 26924      PMRA Submission No.       EPA Registration No.

Product Name: CIL Ant Killer Dust

• Active Ingredient(s)
  • CARBARYL

---

PMRA Registration No. 16782      PMRA Submission No.       EPA Registration No.

Product Name: CIL Ant And Grub Killer Solgard Dust

• Active Ingredient(s)
  • CHLORPYRIFOS

---

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: Res. - Out Home / Rés - à l'ext.maison

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

unknown

To be determined by Registrant

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

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

11

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Adipsia

• Gastrointestinal System
  • Symptom - Loss of appetite

• Nervous and Muscular Systems
  • Symptom - Difficulty walking
  • Symptom - Stiffness

• Skin
  • Symptom - Lesion
  • Specify - abscess and puncture wound

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Owner applied to some ant hills yesterday and the cat was nearby and it sounds like she shooed him away. Owner is afraid that the cat was then exposed later as then she noticed that the cat is not eating or drinking much (did drink some milk) , is lethargic and having trouble walking/stiff. Caller was advised that cats are more sensitive. Chlorpyrifos causes non-typical signs in cats. Predominant neurologic signs are tremors, (especially of the back, top of head, and neck), ataxia, depression, and seizures. Other signs include anorexia, ventroflexion of neck, change in personality, hyperesthesia, and hyperactivity. The most common muscarinic signs are salivation, diarrhea, vomiting and dyspnea. Mydriasis and miosis occur with the same frequency. Depression, anorexia, and tremors can persist for 2-4 weeks. (Intramuscular chlorpyrifos exposure has produced a delayed neuropathy in cats that causes hindlimb ataxia, hypermetria, and proprioceptive deficits about 19 days after exposure). During discussions with regular DVM, it was learn't that the The cat has a puncture wound and an abscess. This is the most likely cause of the clinical signs. Outcome unknown.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here

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