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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4289

2. Registrant Information.

Registrant Reference Number: 4349065

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 Blok

  • 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

Siberian Husky

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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting

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

Owners came home to find that one or both of the dogs had eaten WCS 5 of the 20g blocks of bait. One of the dog (owner isn't sure which) vomited up 2 whole blocks and pieces of more blocks. Owner checked the dogs mouth for evidence of the ingestion and cannot see any green color in either dogs mouth. Both dogs are at home with the owner and are acting normal. The owner was advised that this product is an anticoagulant rodenticide, risk is for coagulopathy. Signs are expected to develop within 3-5 days from exposure. General plan is to either start Vitamin K1 empirically either today or tomorrow morning, OR monitor PT at 48 and 72 hours post-exposure. If start Vitamin K1 empirically then should check PT 48 and 72 hours after final dose of Vitamin K1. Safest option is often to just start Vitamin K1, especially in this case where there is a good chance that there is still a large portion of bait left inside dog. On Jan 23 at 5:15 the operator interacted with dog owner's vet technician with regards to the case. The tech was advised that since we do not know which dog ate the bait and which dog vomited, we would need to have the owner take both dogs to her DVM for 30 days of vitamin k1 on 01/24/10 with a pt test 48-72 hours post last dose or on 01/25/10 and 01/26/10 for pt tests. Owner isn't sure which one she will do. Told owner to give her DVM a call tomorrow and get an estimate on both and give her DVM our numbers to call back. On Jan 23 at 6:36pm Case was discussed with (name) from clinic. Owner has not brought dogs in yet. At this point, would either start Vitamin K1 empirically for 30 days and follow with a PT at 48 and 72 hours after final dose, OR check PT 48 and 72 hours post-exposure. Lori will call owners back to discuss recommendations, which do not include waiting 5 days to bring dogs to clinic. At 7:03pm Owner has called back to see if it is safe for her to go out for a couple of hours. I explained that we do not expect any problems to occur from this exposure until three to five days post exposure, so it should be safe to leave these dogs unattended tonight for a couple of hours. Call back with questions or concerns. On Jan 29 a follow up call was made to monitor the case out, outcome unknown as communication was not made with the owner

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.