Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2227

2. Registrant Information.

Registrant Reference Number: 1916712

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

4. Date registrant was first informed of the incident.

09-APR-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

29-MAR-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)

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PMRA Registration No. 21348      PMRA Submission No.       EPA Registration No.

Product Name: Horticultural Oil

• Active Ingredient(s)
  • MINERAL OIL (INSECTICIDAL)

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PMRA Registration No. 7386      PMRA Submission No.       EPA Registration No.

Product Name: Lime Sulphur

• Active Ingredient(s)
  • LIME SULPHUR OR CALCIUM POLYSULPHIDE

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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 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: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

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

No

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)

Application

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.)

Caller stated that her husband age (age) years, good health, no medication mixed the two contents of a dormant kit and applied it to his trees. At the time of application he didn't wear any protection, his clothing was exposed to the product. According to the caller the day he applied the product he was asymptomatic. Today he wore the same clothes and now has a severe headache and is nauseous. The operator who fielded the call recommended that her husband remove the clothing immediately and wash them separate, also to jump in the shower and remove all residual that may be on his body.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.