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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2813

2. Registrant Information.

Registrant Reference Number: 4649658

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


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. 25301      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Total WipeOut Weed and Grass Killer Concentrate

  • 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).

Site: Res. - Out Home / Rés - à l'

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

spot sprayed weeds according to label instructions

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?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

Owner applied as a spot-sprayed to the weeds according to label instructions yesterday afternoon (5/23) and they kept the dog out of the yard until this morning. Dog was out first this am, and again just now. Dog just vomited about 20 minutes ago. Caller notes Tex did not eat this morning (sometimes he does not eat breakfast). Dog vomited 1x bright yellow (thick saliva, 2-inch circle) (suspect bile). The owner was advised to closely monitor his attitude and digestion tonight through tomorrow morning, want to see him back to normal by morning. no water or food x 1 hr now, then water back and 1 tsp yogurt; if ok after 2 hrs, can graduate to normal feeding tonight; ensure restful and comfortable tonight. During a follow up call the owner stated that Tex is at home and made sure he was kept quiet and comfortable. She followed the NPO plan for one hour. There was no vomiting, so she gave him water and a tsp of yogurt. She waited another 2 hours and still there was no vomiting, so she gave him his food. It was his regular food, not specifically a bland diet as what was recommended. He has not had any GI symptoms. Owner says he seems to have made a full recovery.

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.