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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-4735

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15061695

Registrant Name (Full Legal Name no abbreviations): Matson, LLC

Address: 45620 S. E. North Bend Way - P.O. Box 1820

City: North Bend

Prov / State: Washington

Country: USA

Postal Code: 98045

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

01-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No. 8119-11

Product Name: Eliminator Snail & Slug Bait II - EPA: 8119-11-59144

  • Active Ingredient(s)
    • METALDEHYDE
      • Unknown

7. b) Type of formulation.

Granular

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 / Rs - l'ext.maison

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Rat Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

35

lbs

8. Route(s) of exposure

Unknown

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 - Death
  • Gastrointestinal System
    • Symptom - Nausea
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Specify - passed liquid from rectum
  • Respiratory System
    • Symptom - Other
    • Specify - breathing funny

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rtabli

16. How was the animal exposed?

Other / Autre

specify Unknown Exposure

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Caller stated that during the past month she applied "Eliminator Snail & Slug Bait II" on her backyard, and since yesterday her 12 y.o., 35 lbs dog called Blake developed nausea, some tremors (apparently mild), and passed a small amount of liquid from rectum once, he also was "breathing a little funny". She just took him to a veterinarian who gave IV fluids and 3 shots to control his nausea. Asking if these symptoms could be related to the Snail & Slug Bait? Assesment: Most probably either he ate a small amount, or he ate something else, vs. other medical problems. Continue recommendations provided by veterinarian, keep him posted about any symptoms or changes. If symptoms persist or increase take him back to veterinarian. Explained about the severe toxicity of Metaldehyde and signs of toxicity that occur few hours after ingestion: Depression, salivation, vomiting, diarrhea, hyperthermia, hyperpnea, tachycardia, incoordination, ataxia, stiff gait, muscle tremors. Seizures and opisthtonus in severe cases. Seizures can be continuous. 07/02/07 Folow-up: The dog died at home yesterday. No cause was found for the sxs. She and the DVM think it was "old age" as no ingestion of the product was witnessed.


To be determined by Registrant

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

Death

19. Provide supplemental information here