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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2221

2. Registrant Information.

Registrant Reference Number: 1873378

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.

05-FEB-08

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

21-JAN-08

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. 14058      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Super Mouse Treat

  • Active Ingredient(s)
    • CHLOROPHACINONE

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: Unknown / Inconnu

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

Owner saw dog eating the bait at 4:00 p.m. Eastern time today (about 6.5 hours ago). Owner did not know that it was a rodenticide until she spoke with her father and he informed her that he had come over and set it out.

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

Rottweiler mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

120

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Stomach pain
    • Symptom - Stomach pain
    • Specify - abdominal tenderness

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Owner saw dog eating the bait at 4:00 p.m. Eastern time today (about 6.5 hours ago). Owner did not know that it was a rodenticide until she spoke with her father and he informed her that he had come over and set it out. Owner said the dog ate 1/4 of the 50 g bait (WCS). She does not think her father set more out, but will check with him to be certain. Owner called in to state that her animal was showing signs of abdominal tenderness upon palpation at the E-clinic. Since the vet was not familiar with PT times they decided to start the animal on Vitamin K1. The owner was very grateful with the treatment she received from the vet


To be determined by Registrant

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

Minor

19. Provide supplemental information here

It is unknown as to what actually caused the abdominal pain, the amount ingested is considered to be quite low for a animal of a 120lb size and is considered to be at low risk of developing clinical signs.