Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4723

2. Registrant Information.

Registrant Reference Number: 2035568

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.

24-OCT-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

14-OCT-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. 18992      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Wilsarin, Rat and Mouse Bait Pellets

• Active Ingredient(s)
  • BROMADIOLONE

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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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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 - Difficulty swallowing
  • Symptom - Anorexia

• Respiratory System
  • Symptom - Difficulty Breathing

• General
  • Symptom - Discomfort

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?

Unknown

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 states that she believes that her landlord may have put some of this product out. Caller thinks there is a chance that her cat may have eaten some of the product because yesterday her cat started `not eating, breathing shallow, difficulty drinking, general discomfort. Recommendation was for her to take the cat to the vet at this time for symptoms. Provided caller with case # and direct lines to (name) , have vet give us a call and we will transfer to the NAPCC for treatment recommendations. Give us a call with any questions or concerns. On September 15, 2008 DVM called the kitty is at home and was doing ok and on vitamin K. Just wanted to make sure what type of LA Anticoagulant this is. Case was reviewed with the vet and that this is a LA Anticoagulant that can cause coagulopathies for months. DVM plans vitamin K for 21 - 28 days, then will repeat coags and continue vitamin K as needed.

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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

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