Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-4407

2. Registrant Information.

Registrant Reference Number: 5307149

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

Address: 1900 Minnesota Crt

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N 3C9

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

Domestic Animal

4. Date registrant was first informed of the incident.

25-AUG-14

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

06-JUL-14

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. 26201      PMRA Submission No.       EPA Registration No.

Product Name: Wilson One Shot Wasp & Hornet Killer

• Active Ingredient(s)
  • D-TRANS ALLETHRIN
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PERMETHRIN

---

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).

around a water fountain. 6 cans were purchased, however unknown if all were used.

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

Dog / Chien

3. Breed

Border Collie

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

42

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Loss of appetite

• Respiratory System
  • Symptom - Laboured breathing

• Renal System
  • Symptom - Renal failure

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?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Euthanised / Euthanasie

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

07/06/14 - Caller sprayed this product over a 4 week period into his yard and some of it was ending up in his fountain. The owner is a truck driver and came home for a week with his dog and the dog was drinking from the fountain a lot. It's been 4 weeks now since the week long exposure and the dog is lethargic, losing his appetite and having labored breathing. The owner was advised that severe signs would not be expected and respiratory signs would only be expected if the dog was confined to a room with poor ventilation and a large amt was used. With ingestion mild, self limiting GI signs would be seen. Owner was very upset with our diagnosis. Would not accept any further consult citing that this product is deadly and that we are wasting his time. On August 6, Premier Tech Home and Garden received written communication from the animal owner through the product claims process stating that he wanted financial compensation for the vet bills that had compiled and that he had to put his dog down. The animal was seen three times by several veterinarian's. First couple visits the vet cited that the animal was experiencing kidney problems. The third visit the animals kidney and liver functions were shutting down.

---

To be determined by Registrant

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

Major

19. Provide supplemental information here

Original case was reported through PTHG's consumer health line on July 3, 2014. The Registrant (Sure-Gro IP Inc / business operating as PTHG) became aware of the case on August 25, 2014 as a minor exposure. On August 6, 2014, PTHG received written communication from the animal owner through the product claims process stating that he wanted financial compensation for the vet bills that had compiled and that he had to euthanize his dog as a result of being exposed to a product. To our knowledge confirmation was never made on actual cause to the animal becoming ill and then eventually being put down. Animal owner still suspects pesticide exposure. We are of the opinion that the owner did not exercise enough caution while applying the pesticide, and did not follow the warnings and directions as prescribed on the label.