Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4619

2. Registrant Information.

Registrant Reference Number: 1970812

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.

12-JUL-08

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

13-JUN-08

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)

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PMRA Registration No. 10304      PMRA Submission No.       EPA Registration No.

Product Name: Wilson SlugOut Pellets

• Active Ingredient(s)
  • METALDEHYDE

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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).

Product was placed in the garden.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

15

7. Weight (provide a range if necessary )

8.11

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Muscle tremors
  • Symptom - Ataxia

• General
  • Symptom - Irritable
  • Specify - fractious

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

Caller stated that the product was placed in the garden. Unsure how much if any was ingested. The owner indicated the cat was unable to have full use of her back legs and had tremors. The animal is currently in the clinic. The operator who fielded was put into contact with one of the vet technicians to discuss the case. The technician explained that the Cat is fractious. Cat hasn't had tremors since coming to the clinic as far as we know. Seems less likely that this is the case but do feel that its important to try and get more info about the possible exposure situation. Treating DVM didn't feel that it was a metadehyde exposure. The operator told the vet tech that it seems not highly likely to them but that getting a more detailed history would be beneficial. Outcome unknown

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here