Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1949

2. Registrant Information.

Registrant Reference Number: Prosar 1-18489464

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.

16-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

6. Date incident was first observed.

16-MAY-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)

---

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

Product Name: Corrys Slug/Snail Death (non-specific)

• 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 outside the home on an unknown date.

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

Standard Poodle

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10.5

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

• General
  • Symptom - Lethargy
  • Symptom - Weakness

• Respiratory System
  • Symptom - Laboured breathing

• General
  • Symptom - Death

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-18489464: A reporter (dog owner) called on 05/16/2009 to report the possible exposure of her dog to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the dog was in the treated area when he suddenly became weak, lethargic, and developed labored breathing. No actual product ingestion was witnessed. At the time of the report, the dog was at the veterinary clinic under treatment. The reporter was advised that the product is highly toxic in small amounts and may result in signs of muscle tremors, hyperthermia, depression, salivation, vomiting, diarrhea, dyspnea, tachycardia, in-coordination, ataxia, stiff gait, and seizures. The caller was advised that prompt veterinary evaluation is required in order to decontaminate and treat the signs. The attending veterinarian was in contact a short time after the initial reporter's call. The veterinarian stated that he is familiar with metaldehyde toxicity and the dog's signs are not consistent with what he has previously seen. At the time of his call, the dog was weak but did not have any muscle rigidity or muscle tremors. The veterinarian had instituted IV fluids and was ruling out other causes for the signs. Metaldehyde toxicosis and treatment were reviewed with the veterinarian. On follow up, the original reporter stated that the dog died while at the veterinary clinic. The cause for the dog's signs was not determined. 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