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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4676

2. Registrant Information.

Registrant Reference Number: 1995478

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.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 26679      PMRA Submission No.       EPA Registration No.

Product Name: Green Earth Ant Roach Insect Dust

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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).


To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


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


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Renal System
    • Symptom - Blood in urine
  • Gastrointestinal System
    • Symptom - Rectal hemorrhage
    • Specify - Bleeding from the rectum

12. How long did the symptoms last?

Unknown / Inconnu

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


15. Outcome of the incident


16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

The caller states her mom's dog may have been exposed to the Green Earth Ant and Roach Insect Dust placed down under the rug a couple of days ago and also off and on for a couple of weeks, the dust is covered by a rug but he dog food is next to the rug and may have walked through some of the dust last night at about 6pm. The dog stopped eating and the dog was bleeding out of rectum and penis last night and taken to the vet, he has been at the vets since last night and just came home from the vet and was told the dog may die and asking if the dog into any roach or ant killer with warfarin? The dog is a terrier poodle mix. The operator advised the caller that the registration number she referenced contains only the active called Diatomaceous Earth (Silicon Dioxide) and doubts that the symptoms that the dog is exhibiting is related to this product.

To be determined by Registrant

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


19. Provide supplemental information here

We do not support the claims of this case as diatomaceous earth has been found to be non toxic to both animals and children.