Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5745

2. Registrant Information.

Registrant Reference Number: Prosar 1-16965699

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.

25-NOV-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

25-NOV-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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 8119-13

Product Name: Corrys Slug/Snail Pellets MP 2 lb

• Active Ingredient(s)
  • METALDEHYDE
    • Guarantee/concentration 3.25 %

---

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 product was applied to the garden on 11/24/2008.

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

Yorkshire Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

9

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

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?

Other / Autre

specify Unknown if product exposure occurred

17. Provide any additional details about the incident

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

1-16965699: A reporter called on 11/25/2008 to report the possible exposure of a dog to a snail and slug bait containing the active ingredient Metaldehyde. According to the reporter, the product had been applied to the garden on 11/24/2008. The reporter found the dog dead this morning. Actual product exposure was not witnessed, and the reporter could not determine whether the product had been disturbed. The reporter wanted to know about the product's toxicity. The reporter was advised that the product is highly toxic, even in small amounts. The clinical signs following product ingestion include tremors and seizures, leading to hyperthermia. Because product exposure could not be confirmed, a recommendation was made to discuss the dog's death with a veterinarian. No further information was obtained.

---

To be determined by Registrant

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

Death

19. Provide supplemental information here