Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4645

2. Registrant Information.

Registrant Reference Number: 1984640

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.

13-AUG-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

02-JUL-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. 19228      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Earwig Destroyer

• Active Ingredient(s)
  • CARBARYL

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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 III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy
  • Symptom - Drowsiness
  • Symptom - Restlessness

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

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

Caller says that dog is acting different, uncertain if dog ingested product. Dog has just arrived from arctic circle and 24 hour lighting. Could behavior be due to product exposure. Dog is acting sleepy, but does not rest, is getting up and moving around. Dog is also `stretching out neck` often. Recommendations: Exposure to product expected to cause 1) It is unlikely the symptoms experienced are related to this product 2) If symptoms persist or worsen, follow up with DVM 3) The MSDS can be faxed to the DVM. If dog had ingested product ,dilute with water, wash muzzle and paws. Observe for changes in eating habit/bowel movements, vomiting. If symptoms occur or persist seek DVM evaluation.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here