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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-5398

2. Registrant Information.

Registrant Reference Number: 4921846

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.

08-AUG-12

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

12-JUL-12

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. 18992      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Wilsarin Rat and Mouse Bait Pellets

  • Active Ingredient(s)
    • BROMADIOLONE

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: Res. - Out Home / Rés - à l'ext.maison

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

Garage

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

Cocker Spaniel

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

29

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Licking

12. How long did the symptoms last?

Unknown / Inconnu

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

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 had filled up bowl with one bag of the pellets yesterday, and she had placed the bag in the garage. When she came home from work, the bag of pellets was gone. Today, she put another bag of pellets in a bowl, and when she came back, the pellets were still there. She then left the house and accidently left the door to the garage open. When she returned, Murphy came out of the garage licking his lips. Most of the pellets were gone, but there were some scattered on the floor. She estimates that the exposure happened around 18:00 CT. Murphy is asymptomatic. Owner does not believe that Murphy got to the bait yesterday because it was in the garage, and the garage door was closed. Caller was informed that this is an anticoagulant and they can cause coagulation problems. Caller was advised to induce vomiting. At 8pm, Spoke with the owner, dog did vomit and about half the bait came up. Would still highly rec K1 in the AM due to large amount ingested. On July 16, The owner called in to update the case. The owner believes that Murphy ingested more of the bait that originally suspected. She told me that she believes Murphy ingested another 50g pack on Tuesday, 7/10/12, evening. She took Murphy to the clinic on 7/13/12. The dog was given an injection of k1 along with AC. The DVM sent six 2.5ml syringes of k1 home with the owner (unknown strength). The owner that this duration of treatment is not long enough and consulted with Dr. Smith. per Dr. Smith, the pet needs to be on an additional 15 day supply of k1. Have the clinic call us. Pt 48-72 hours post last dose of k1. Later on that day the owner called back to further update on the case, according to her he has dispensed Vit K1 in injectable form because they do not have any other form in Canada. Currently pet is receiving 30 mg SQ BID for 6 days only. Told O that the bromodialone can stay in the system for 21 days, so pet needs to be on VitK for at least 21 days. Recommended she ask DVM about potentially getting the medication from a human pharmacy in capsule form. O wanted to know if what she is giving could cause pet harm. Told her that we do not normally recommend injectable form because we have seen anaphylactic type reactions. It is preferable to give oral meds. Told O to have DVM call us if there is confusion about the dosing regime. She said he does have the case and phone number. She will contact DVM in the morning.


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.