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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4631

2. Registrant Information.

Registrant Reference Number: 1971715

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.

12-JUL-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

15-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)

PMRA Registration No. 25700      PMRA Submission No.       EPA Registration No.

Product Name: Hillview Farms Kitty Comfort Anti Bacterial Clumping Kitty Litter

  • Active Ingredient(s)
    • BRONOPOL

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).

Outside litter box for the cat.

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

Golden Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

80.0

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Anorexia
    • Symptom - Diarrhea
    • Symptom - Constipation

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify accidental ingestion of Kitty Litter

17. Provide any additional details about the incident

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

Owner has been doing some gardening. When she digs the soil, she noticed the cat had been using the soil as a litter box. Owner decided to make a litter box outside for the cat about 2 days ago. She did not put it up high enough, and the dog was able to get into it. She does not know how much the dog might have ingested. She noticed later on that day that the dog was acting a little ill. Yesterday, she actually saw the evidence of the litter on the dogs face. Dog is vomiting when she eats, anorexic, constipated, and when she does defecate, it is a small amount of diarrhea. The owner was advised to take the dog into the vet that night, if they could not it was suggested to try and manage the vomiting by giving the dog 1.5 T Mallox, once tonight, and once tomorrow morning. Encourage dog to drink and eat. Feed bland diet tonight.


To be determined by Registrant

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

Minor

19. Provide supplemental information here