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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4669

2. Registrant Information.

Registrant Reference Number: 1986369

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.

06-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)

PMRA Registration No. 19228      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Earwig Destroyer

  • Active Ingredient(s)
    • CARBARYL

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

Medical Professional

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 )

4

7. Weight (provide a range if necessary )

36

kg

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Muscle twitching
    • Specify - Facial Twitching
    • Symptom - Trembling
  • Gastrointestinal System
    • Symptom - Fecal incontinence
  • Renal System
    • Symptom - Urinary incontinence

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

12

Hour(s) / Heure(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

Call came in from a vet indicating that they have a dog that has been exposed to some earwig bait containing carbaryl. The exposure was accidental, and occurred at animal owner home. The dog is reported to have ingested up to 4 TBSPs of the product 11 hours ago on July 06, 2008 at 07:39 AM. Because the amount was generally consistent, the patient was considered to be at high risk of developing clinical signs. If signs develop, there is low risk that those signs will be life-threatening. The animal has already started to exhibited sign which include hypersalivation, facial twitching, tremors, Trembling, fecal and urinary incontinence. It was advised that the vet administer atropine which is the antidote to carbaryl. At 4pm later that day the vet clinic called back to discuss the case and has indicated that the symptoms are starting to resolve and wanted to know if it would be OK to send the dog home if there are no clinical signs at around 8pm this evening. Outcome the animal is fully recovered.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here