Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4875

2. Registrant Information.

Registrant Reference Number: 4168276

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-JUL-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

02-JUN-09

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. 19228      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Earwig Destroyer

• Active Ingredient(s)
  • CARBARYL

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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

Dog / Chien

3. Breed

Beagle

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

33

lbs

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 - Diarrhea
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Muscle trembling

• Respiratory System
  • Symptom - Panting

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

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

The owner stated that the Dog had ingested some amount of the product about 1:30 or 2:00. It was not the full bag, there is still a third of the bag left. Dog got sick immediately, vomiting and diarrhea. Back end was shaking. Has been at vet for last 5 hours. Vet has given dog atropine,. activated charcoal, IV furflo, and norfal. Now dog is acting fine. Vet recommended that she go to an overnight vet, the owner wants to know if that is necessary. The owner stated that the pet was treated initially by the thier vet and then she transferred the dog to the E clinic. She chose not to treat the pet at the E clinic due to the cost. She managed the pet at home, monitoring closely overnight. The pet had fully recovered by the following morning. A few days later however, the dog found the last of the bait that the owner did not remove from the yard. She ingested the bait again and the same signs developed. The owner decided to manage this at home and not treat at the vet this time. The dog made a full recovery after 24 hours after the second ingestion. The owner has now removed all of the bait from the yard.

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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.