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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4285
2. Registrant Information.
Registrant Reference Number: 4349098
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.
09-FEB-105. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
24-JAN-10Product 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. 19228 PMRA Submission No. EPA Registration No.
Product Name: Wilson Earwig Destroyer
- Active Ingredient(s)
- CARBARYL
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
Maggie
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
10
7. Weight (provide a range if necessary )
40
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
>15 min <=2 hrs / >15 min <=2 h
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Nervous and Muscular Systems
- Symptom - Seizure
12. How long did the symptoms last?
>2 hrs <=8 hrs / > 2 h < = 8 h
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 was out of the house from approx 1530 to 1730. While she was gone, the dog ingested an unknown amount of the product. There was nothing else the dog may have gotten into. The owner was advised that this products is a carbamate insecticide of moderate toxicity. Typically muscarinic signs are first seen and include salivation, lactimation, urination and defecation, along with miosis, vomiting and bradycardia. Nicotinic signs may include twitching, weakness and tremors. CNS signs of hyperactivity and seizures may be seen with high doses. The owner was advised to take the animal into their local DVM. On Jan 27during a routine follow up call the owner had advised that she did take Maggine directly into the DVM. By the time she arrived at the clinic, the dog was vomiting and having seizures. The DVM administered AC and Atropine. The signs ended within about 12 hours. The dog is now back at home, doing very well.
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.
