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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2815

2. Registrant Information.

Registrant Reference Number: 4646929

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.

10-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

19-MAY-11

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)

PMRA Registration No. 28352      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Predator Rat and Mouse Killer Blok

  • Active Ingredient(s)
    • DIFETHIALONE

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Unknown / Inconnu

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

in locked bait stations

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

Cat / Chat

3. Breed

Domestic Short Hair

4. Number of animals affected

2

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

8.5

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 - Vomiting

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify ingestion of suspected poisoned mouse

17. Provide any additional details about the incident

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

Pet owner put the bait out in lock boxes. Yesterday morning at 4am they caught the cats playing with a mouse that they had killed. Worried about a relay exposure. Cats have vomited The owner was advised that because the amount was poorly consistent, the patient was considered to be at low risk of developing clinical signs. Coagulopathy can occur following significant exposures to difethialone. Relay toxicosis is unlikely and rare unless the mouse ingested a full belly of the product before dying or was killed by the pets shortly after ingesting some. Owner then indicated that the pets had killed the mouse. The owner was then advised in that case, can take the cats in to the DVM for a PT test at 72hours post the exposure to check clotting times, if times are normal at that point pets are in the clear, or can immediately start the pets on vitK1 for 30 days. Would not expect GI upset as a result of this exposure, can be as a result of the dietary indiscretion of eating a mouse or some other cause. If continues, would consult with your DVM about that as well. Outcome unknown


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. The owner has no actual proof that the mouse had in fact ingested the bait.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Short Hair

4. Number of animals affected

2

5. Sex

Male

6. Age (provide a range if necessary )

2.5

7. Weight (provide a range if necessary )

8.5

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 - Vomiting

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify ingestion of suspected poisoned mouse

17. Provide any additional details about the incident

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

Pet owner put the bait out in lock boxes. Yesterday morning at 4am they caught the cats playing with a mouse that they had killed. Worried about a relay exposure. Cats have vomited The owner was advised that because the amount was poorly consistent, the patient was considered to be at low risk of developing clinical signs. Coagulopathy can occur following significant exposures to difethialone. Relay toxicosis is unlikely and rare unless the mouse ingested a full belly of the product before dying or was killed by the pets shortly after ingesting some. Owner then indicated that the pets had killed the mouse. The owner was then advised in that case, can take the cats in to the DVM for a PT test at 72hours post the exposure to check clotting times, if times are normal at that point pets are in the clear, or can immediately start the pets on vitK1 for 30 days. Would not expect GI upset as a result of this exposure, can be as a result of the dietary indiscretion of eating a mouse or some other cause. If continues, would consult with your DVM about that as well. Outcome unknown


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.