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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5539

2. Registrant Information.

Registrant Reference Number: 4672117

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.

13-JUL-11

5. Location of incident.

Country: CANADA

Prov / State: BRITISH COLUMBIA

6. Date incident was first observed.

27-JUN-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. 27492      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Riddex Bloks Rat and Mouse Bait

  • Active Ingredient(s)
    • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM SALT)

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

1.9

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • 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.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

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

Owner stated that prior to moving into this household they noticed that there was some rat bait in and around the home. Owner removed the bait. Recently the dog was purchased and brought into the home. Owner stated that they returned form being away from the home one afternoon and found blue flecks on the floor, and they had no idea what the flecks were. Last Thursday the owner then noticed by that evening that the dog's feces was blue, however the dog did not develop any symptoms at that time. Today the dog was found to have a blue chunk of bait in her bed ( out of a 450g package , the piece the dog could have gotten into was 2in x 4in. the owner found a piece that's 2in x 3in.) and feels that this is connected to the fact that feces was blue. Owner looked up how to induce emesis on the internet and gave 1Tbs of hydrogen peroxide. Dog vomited, no blue flecks were observed. (on Jun 26, 2011 at 06:15 PM). The owner was advised that there could be some significant risk for both exposures (Thursday and today) resulting in coagulopathy. This product contains diphacinone (an anticoagulant) and malathion (an organophosphate insecticide). Anticoagulants may lead to a coagulopathy. Clinical signs may not be seen prior to death but may include lethargy, depression, abdominal distension, dyspnea, bruising, epistaxis, and rectal bleeding. Coagulopathies develop 3-5 days post exposure. The OP ingestion may result in SLUDDE signs (lacrimation, hypersalivation, urination, defecation), bradycardia, and dyspnea. And possible nicotinic signs agitation, twitching, tremors, and weakness. The owner was advised to take the animal to their veterinarian. Caller called back to find out what exactly the company will pay for in regards to our consultation vs vet clinic bills. During a routine follow up call to update the case the number that was given ended up in the caller stating wrong number. 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.