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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-2545
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16126411
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.
09-MAY-085. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
09-MAY-08Product 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. 8119-13
Product Name: Corrys Slug and Snail Pellets
- Active Ingredient(s)
- METALDEHYDE
- Guarantee/concentration 3.25 %
- METALDEHYDE
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 / 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).
The box of product was found torn open on 5/9/08. The reporter assumed it was a new box and assumed her father had brought it to her home and applied it to her lawn. The reporter had been gone all day but assumed her 2 dogs had torn the box and gotten into the product - it was scattered in rocky areas of the yard where someone would not have intentionally applied the bait.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
Mixed Breed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
60
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
- Nervous and Muscular Systems
- Symptom - Trembling
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Diarrhea
- General
- Symptom - Death
- Respiratory System
- Symptom - Respiratory failure
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?
Yes
14. b) How long was the animal hospitalized?
1
Day(s) / Jour(s)
15. Outcome of the incident
Died
16. How was the animal exposed?
Other / Autre
specify No witnessed exposure - box was torn and product scattered when owner came home; presumed the 2 dogs tore the box
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16126411: The reporter called on 5/9/08 to report she had found a box of product containing the active ingredient Metaldehyde torn open. The reporter stated she assumed it was a new box and assumed her father had brought it to her home and applied it to her lawn. The reporter had been gone all day but assumed her 2 dogs had torn the box and gotten into the product - it was scattered in rocky areas of the yard where someone would not have intentionally applied the bait. According to the reporter, both the dogs were asymptomatic at the time of the call. A recommendation was made to take the dogs immediately to a veterinarian and to take the package with. A follow-up call on 5/12 revealed both dogs had been taken to a veterinarian on 5/9. Enemas had been given, vomiting had been induced and they had been placed on IV fluids. The dogs had developed tremors, diarrhea, and vomiting while at the clinic. One of the dogs (1st subform III) had died of respiratory failure on 5/10. The other dog had been discharged and was doing well.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Mixed Breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
40
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
- Nervous and Muscular Systems
- Symptom - Trembling
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Diarrhea
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
1
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Other / Autre
specify No witnessed exposure - box was torn and product scattered when owner came home; presumed the 2 dogs tore the box
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16126411: The reporter called on 5/9/08 to report she had found a box of product containing the active ingredient Metaldehyde torn open. The reporter stated she assumed it was a new box and assumed her father had brought it to her home and applied it to her lawn. The reporter had been gone all day but assumed her 2 dogs had torn the box and gotten into the product - it was scattered in rocky areas of the yard where someone would not have intentionally applied the bait. According to the reporter, both the dogs were asymptomatic at the time of the call. A recommendation was made to take the dogs immediately to a veterinarian and to take the package with. A follow-up call on 5/12 revealed both dogs had been taken to a veterinarian on 5/9. Enemas had been given, vomiting had been induced and they had been placed on IV fluids. The dogs had developed tremors, diarrhea, and vomiting while at the clinic. One of the dogs (1st subform III) had died of respiratory failure on 5/10. The other dog had been discharged and was doing well.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
