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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4891

2. Registrant Information.

Registrant Reference Number: 4193617

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. 28352      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Predator Rat and Mouse Killer

  • 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).

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

Yorkshire Terrier

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?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Abnormal feces colour

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

Caller stated that his Dog "Chewy" had access to the block from 12- 1:30 CT and ate mostly 1/2 of one block. He is currently asymptomatic. His owner gave him a meal after that (unspecified time) and a family member gave him half of a peach after that (also unspecified time). Caller was advised to try and induce vomiting to try and recover some of the bait. If not much is recovered, can start Vitamin K1 x 30 days. Gave owner detailed instructions on how to induce. Chewy just ate, no need to feed prior to peroxide. Owner will call back with emesis results. The owner called back, the dog hasn't vomited after 1 dose of peroxide. It is active. Repeat, call us back. Chewy has had 2 doses of active H2O2 and has not vomited. Per the Dr.s recommendation we would be concerned about this exposure. Owner should take Chewy into the DVM to start Vitamin K-1 on either. Owner called back. He reports that he noticed this am that the color of the dog's stool this am was similar to the rodenticide. He wondered if he still needed to take the dog to the DVM. Advised owner that the color of the bait that he was seeing is most likely just the dyes in the product. The active ingredient most likely has been absorbed. Recommend taking the dog to the DVM as originally recommended

To be determined by Registrant

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


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.