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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-6839

2. Registrant Information.

Registrant Reference Number: 5677370

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


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. 19228      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Earwig And Cutworm Destroyer

  • 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

Miniature Pinscher

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?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

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

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Fasciculations
  • Gastrointestinal System
    • Symptom - Inappropriate defecation

12. How long did the symptoms last?

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

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

Dvm said the pet was caught getting into the product 1.5 hrs ago. Unknown how much was ingested. The pet became symptomatic 45 min ago. She is ataxic, twitching, and unable to control her feces(dropping out). They did give a dose of atropine. Wants to know what the next step is. Does not think there has been a prior exposure to the bait. Discussed case with DVM. Pet's HR was 100 on presentation, now is 180 post atropine. DVM found evidence of the product in the vomitus (liquid). DVM is guessing about 10g of the product was recovered in the pet's vomitus. DVM is not seeing evidence of drooling, bronchial secretions. Reviewed with DVM that carbaryl has a wider margin of safety - typically if we seen problems they are the SLUDDE signs. Only at very high dose would expect to see tremors, fasciuculation and seizures. Discussed when to use atropine, treating CNS signs. DVM asked about charcoal - hard to say for sure as signs are not consistent with what I would expect, but with recent evidence of product in vomitus would indicate there may be something to bind too. On Aug 30, 2016 at 06:38 PM ERDVM calling with an update. The dog was discharged about 24 hrs after presentation. All signs had resolved.

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.