Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2008-0337

2. Registrant Information.

Registrant Reference Number: 07152007

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.

Human

Packaging Failure

4. Date registrant was first informed of the incident.

11-SEP-07

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

15-JUL-07

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. 27013      PMRA Submission No.       EPA Registration No.

Product Name: Later's Grass and Weed Killer Ready To Use

• Active Ingredient(s)
  • GLYPHOSATE (PRESENT AS ISOPROPYLAMINE SALT OR ETHANOLAMINE SALT)

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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).

To be determined by Registrant

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

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Bleeding

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

No

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Other

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

None

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

As per the doctor's notes, the patient suffered an abrasion to the left shin when exposed to the bottle dropping while brushing up against his left leg as a result of the lid coming detached from the bottle. The product was immediately washed off at the store where the incident happened and first aid given. No mention of treatment or any symptoms were identified pertaining to the abrasion the medical records.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

As mentioned in the supplemental information on the packaging sub form, all information gathered throughout the correspondence with the exposed consumer, it seems like the bottle was tampered with at the store resulting in the product spilling all over the left leg of the consumer.

Subform VI: Packaging Failure

1. What is the type of packaging that failed?

Bottle-plastic / Bouteille-plastique

2. Did packaging failure occur during?

Other

specify Picking the bottle up by the sprayer after purchasing it at the cashier.

3. Did packaging failure result in?

potential injury

4. Describe how the packaging failed and the surrounding circumstances, including a description of the potential injury or exposure.

According to the consumer who was purchasing a bottle of Grass and weed Killer, went to pick the bottle up by spray nozzle after purchasing it. The bottle in question came apart where the nozzle screws onto the bottle. The nozzle itself did not come apart, nor did the bottle break at the neck.

For Registrant use only

5. Provide supplemental information here.

It seems like given the location of the incident and the verified correspondence through e-mail where he stated that the bottle did not break, just the nozzle came apart from the bottle. It is highly suspect and plausible that the bottle was tampered with at the store and left there intentionally for a person to purchase and then be potentially exposed to.