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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-5979

2. Registrant Information.

Registrant Reference Number: 5429072

Registrant Name (Full Legal Name no abbreviations): Sure-Gro IP Inc.

Address: 1900 Minnesota Crt

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5N 3C9

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: QUEBEC

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. 29166      PMRA Submission No.       EPA Registration No.

Product Name: Green Earth Homecare Mouse And Rat Killer Pellet

  • 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

Manchester 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

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

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
    • Symptom - Abnormal feces colour

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?


Day(s) / Jour(s)

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

Dog got to the bait sometime over night. It had been placed a couple weeks ago. This am the dog is vomiting and having diarrhea. Color of vomit and stool is fluorescent green. Owner has brought to DVM. Per the vet there was about 1 cup worth of bait put out initially. Discussed the case with the RDVM. The dog is stable at this point. She contacted the PCO first who said this wouldn't be a problem, then contacted the company for the product, who transferred her to us. Discussed the effects of the cellulose bait-typically in dogs our concern is for gastroenteritis. Obstruction is possible, but rare. Typically treatment is supportive. Would want to make sure there are no other possible baits from the past out that the pet could have had access to. On March 27, called back about Romeo. He's clinically doing well, eating, and is on IV fluids. His stools are crumbly and still green, but the stool in his colon feels normal and not hard. He's had 2 doses of Cerenia, yesterday and the day before, and has not had any vomiting. Wondering if he could go home today and be off of fluids, or if he should stay until stools are normal? And if she should send him home with any oral meds or add fiber to the diet? If he's eating well and BAR, and the material is passing, she could send him home. If she wants to continue the canned food to aid in it passing and giving him more fluid intact, that would be fine as well. Usually the biggest concern for the product to absorb water, and possibly lead to a blockage would be within the first 24 hours.

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.