Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4629

2. Registrant Information.

Registrant Reference Number: 1966902

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.

12-JUL-08

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

09-JUN-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. 23069      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Ambush

• Active Ingredient(s)
  • PERMETHRIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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: Female

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

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Burning skin

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.)

Female caller stated that she was exposed WIlson Ambush Tree and Garden insect killer while spraying the lawn for 1hour end of July beginning of August in 2007. The spray drifted on to her unprotected legs at which at the time she had washed within soap water. Last year she had experienced a burning sensation on her legs. In April 2008, she went to (location) for a vacation and was sun tanning. While sun tanning she had experienced some burning sensation like last summer when she used product. Concerned about long term effects. She indicated that the burning sensation resolved 2.5 days later, however she did experience small eruptions on the leg after trip to (location) this year. Her MD told her to use aveeno bath for the sunburn and to wash the area with soap and water repeatedly. The operator who fielded the call explained to the caller that symptoms of permethrin are not expected to have long term effects with decontamination of superficial dermal exposure.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.

We do not support the claims expressed in the above case to be related to the product. Also Lawn application is not a registered use for this product and is a misuse of the product.