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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4718

2. Registrant Information.

Registrant Reference Number: 2045073

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.

14-OCT-08

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

20-SEP-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. 24947      PMRA Submission No.       EPA Registration No.

Product Name: CIL Total Wipeout RTU

  • Active Ingredient(s)
    • GLUFOSINATE AMMONIUM

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).

unknown

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

Border Collie

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

50

lbs

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

  • Gastrointestinal System
    • Symptom - Vomiting

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

Unknown/Inconnu

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

Owner sprayed yard on September 20, 2008. Kali (family dog) started vomiting on this day. Kali has been vomiting from last Saturday Sept. 20 to Tuesday Sept 22. The owner thinks Kali may have eaten some grass. No known exposure for the dog. The owner was advised that Glufosinate ingestion is typically associated with GI upset. Serious ingestions can result in delayed neuro signs including seizures and respiratory failure, potentially increased liver enzymes, leukocytosis, generalized edema, and fever. These severe signs would not be expected from a typical exposure. On September 26, the operator who fielded the initial call spoke with the veterinarian treating the animal and explain that they would not expect this degree of illness with a typical exposure to the product (details not specified, though). I recommended treating the dog for nonspecific pancreatitis/cholangiohepatitis. On Spetember 30, 2008 a follow up call with the animal owner,the pet is still receiving treatment in clinic. Pet is active, but the liver values are still elevated. Pet is currently being treated symptomatically. Bilirubin values have normalized. Clinic is waiting on a medication to be shipped that is supposed to help liver values, owner is unsure of name. Pet is still not eating a normal amount


To be determined by Registrant

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

Major

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified