Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2546

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16172464

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.

21-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

20-MAY-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.       PMRA Submission No.       EPA Registration No. 8119-13-71376

Product Name: OSH Slug and Snail Killer Mini Pellets

• Active Ingredient(s)
  • METALDEHYDE
    • Unknown

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7. b) Type of formulation.

Bait

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 reporter applied the product on 5/19/08.

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

Pomeranian

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

5

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

• Nervous and Muscular Systems
  • Symptom - Shakiness

• Gastrointestinal System
  • Symptom - Drooling

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-16172464: The reporter called on 5/21/08 to report she had applied a product containing the active ingredient Metaldehyde 2 days previously. The reporter had thought one of her dogs (2nd subform III) had ingested some product on 5/20, as it had developed tremors that morning. That dog had been taken to a veterinarian for treatment, and had been discharged later that same day after its symptoms resolved. The reporter had subsequently tried to remove all the bait from the treated area. During the 5/21 call, the reporter revealed that another of her dogs (1st subform III) had just developed tremors and drooling. The safety profile of the product was discussed and a recommendation was made to take the dog to a veterinarian immediately. The reporter called a few hours later to reveal the dog most recently exposed (1st subform III) had passed away en route to the veterinarian.

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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

Bichon Frise

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

12

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

• Nervous and Muscular Systems
  • Symptom - Trembling

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.

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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

1-16172464: The reporter called on 5/21/08 to report she had applied a product containing the active ingredient Metaldehyde 2 days previously. The reporter had thought one of her dogs (2nd subform III) had ingested some product on 5/20, as it had developed tremors that morning. That dog had been taken to a veterinarian for treatment, and had been discharged later that same day after its symptoms resolved. The reporter had subsequently tried to remove all the bait from the treated area. During the 5/21 call, the reporter revealed that another of her dogs (1st subform III) had just developed tremors and drooling. The safety profile of the product was discussed and a recommendation was made to take the dog to a veterinarian immediately. The reporter called a few hours later to reveal the dog most recently exposed (1st subform III) had passed away en route to the veterinarian.

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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