Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2228

2. Registrant Information.

Registrant Reference Number: 1918028

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: ONTARIO

6. Date incident was first observed.

31-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. 27905      PMRA Submission No.       EPA Registration No.

Product Name: CIL Ant Killer RTU

• Active Ingredient(s)
  • PERMETHRIN

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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. - In Home / Rés. - à l'int. 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: <=1 yr / < = 1 an

3. List all symptoms, using the selections below.

System

• Gastrointestinal System
  • Symptom - Vomiting

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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)

Contact with treated area

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.

Unknown

11. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

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 had applied the ant killer RTU over the last week and that her and her son have been gone away and just returned home. Have been home for the last 45 minutes; no direct contact with product; simply entered home and she is concerned if their is any effect from breathing or being in the same environment were product has been in use. She indicated that her son vomited x 1 immediately following normal feeding of baby formula. The caller was advised that the symptoms were non consistent with noted exposure and should consult with pediatrician. Mother requested follow up call, with no response from the mother. Outcome unknown.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

As per the web site, www.babycenter.ca, it's common for babies to vomit frequently in the early weeks as they adjust to feeding and as their bodies develop. It is noted that during your baby's first few months, vomiting is probably due to mild feeding problems such as overfeeding or a temporary allergy to proteins in breast milk or formula.