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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-6074

2. Registrant Information.

Registrant Reference Number: 5468325

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: ONTARIO

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. 18992      PMRA Submission No.       EPA Registration No.

Product Name:

  • 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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Golden Retriever Mix

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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms


  • Renal System
    • Symptom - Other
    • Specify - Elevated Kidney Values
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea

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


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

On June 5, Callie developed vomiting and diarrhea. The owner took her to a DVM on June 6, thinking she had ingested bait. The PT and PTT were both elevated and they started on K1. On June 10, they ran kidney values and found the BUN and Creat are both elevated as well. Is this related? R: Because the amount was unknown consistent, the patient was considered to be at high risk of developing clinical signs. Ingestion of this agent can result in significant prolongation of clotting times and life threatning hemorrhage. Jun 16, 2015 at 10:54 AM, Discussed the case with the DVM. Vomting and diarrhea is not common with ingestion of this agent and elevated renal values are not expected. Jun 18, 2015 at 08:53 AM Further diagnostics show that the dog is having some kidney issue and the doctor wants to know if anti coagulants effect the kidneys. Discussed with treating DVM. The only way that I can see an anticoagulant rodenticide leading to renal changes would be if there had been hematuria. Use of injected K3 has been linked with acute renal injury in some species (especially horses), but not oral The lab work reported from yesterday strikes me as more chronic, need to rule out lymphoma, other causes for renal injury in an elderly. Final outcome unknown

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here

Animal Owner communicated that exposure was malicious. 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.