Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5434

2. Registrant Information.

Registrant Reference Number: 1947167

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.

Human

4. Date registrant was first informed of the incident.

11-JUN-08

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

12-MAY-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. 27068      PMRA Submission No.       EPA Registration No.

Product Name: Later's Bugban-C Ant Killer Dust

• Active Ingredient(s)
  • CARBARYL

---

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 II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Medical Professional

2. Demographic information of data subject

Sex: Male

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Anxiety

• Gastrointestinal System
  • Symptom - Salivating excessively

• General
  • Symptom - Lightheadedness

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Drift from the application site

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>2 hrs <=8 hrs / > 2 h < = 8 h

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Telephone call came in from a medical doctor at the (name) Hospital regarding patient whom was using 5 % Later's Bugban- C ant killer dust. The wind shifted, and patient inhaled some of the dust, concerned about the active ingredient carbaryl and requested kg/toxic dose, inhalation was brief time of exposure 3hrs ago. Patient general healthy, history of bipolar, medications unknown (didn't have the names on hand). no known allergies. The patient is displaying symptoms of anxiousness, hyper salivation and light-headedness. The operator who fielded the call advised the Doctor that inhalation exposure that the symptoms displayed are unknown if related per the MSDS for the Laters Bugban-C Ant Killer Dust product. The active ingredient Carbaryl which is a reversible cholinesterase inhibitor. The antidote is atropine sulphate. Recommendations were to decontaminate patient with fresh air, wash off contaminated skin w/ soap and water and to give atropine if cholinergic symptoms occur. Outcome unknown as follow up call was made and the Medical Doctor who made the initial phone wasn't in and the patient name was unknown.

To be determined by Registrant

14. Severity classification.

Minor

15. Provide supplemental information here.