Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1592

2. Registrant Information.

Registrant Reference Number: Prosar 1-17990650

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.

02-APR-09

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

02-APR-09

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
    • Guarantee/concentration 3.25 %

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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 product had been placed outside the home at an unknown time.

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

Female

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

Unknown

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 - Seizure

• 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 exposure occurred.

17. Provide any additional details about the incident

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

1-17990650: A reporter called on 04/02/2009 to report the possible exposure of her dog to a slug and snail product containing the active ingredient Metaldehyde. According to the reporter, the dog lives outside and the product had been placed in an area that was thought to be inaccessible to the dog. The reporter's husband went outside and found the dog having a seizure. It was unknown how long the seizure had been going on. It was also unknown whether the dog had exposure to the product. The reporter mentioned that her neighbors had poisoned her pets in the past. The reporter was advised that the product is highly toxic in small amounts. It acts rapidly so early and aggressive decontamination and treatment is essential. The product may cause muscle tremors, hyperthermia, vomiting, depression, dyspnea, ataxia, and a stiff gait. Seizures may occur with severe toxicity and may be continuous. Death can occur secondary to respiratory failure. Dogs surviving the acute phase may develop liver damage 2-3 days after exposure. The reporter was advised to take her dog to the veterinarian immediately. On follow up, the reporter stated that the dog had died by the time the caller finished reporting the incident on 04/02/2009. No further information was obtained.

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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

Exposure to the product was not witnessed.