Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2336

2. Registrant Information.

Registrant Reference Number: Prosar 1-18993237

Registrant Name (Full Legal Name no abbreviations): Matson, LLC

Address: 45620 S.E. North Bend Way-PO 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.

29-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

29-JUN-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

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

• 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 was applied in a yard on 06/28/2009.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Cocker Spaniel

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

13

7. Weight (provide a range if necessary )

25

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 - Muscle tremors
  • Specify - "Chronic tetany"

• Respiratory System
  • Symptom - Laboured breathing

• Gastrointestinal System
  • Symptom - Diarrhea

• 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?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Exposure was not witnessed-suspect accidental ingestion

17. Provide any additional details about the incident

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

1-18993237: A reporter (veterinarian) called on 06/29/2009 to report the possible exposure of a dog to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the dog's owner had applied the product in the yard on 06/28/2009. The dog would have had exposure to the treated area but actual ingestion was not witnessed. On 06/29/2009, the owner's found the dog with unknown symptoms. The dog presented to the reporter in chronic tetany with diarrhea and labored breathing. The reporter was advised that the active ingredient is highly toxic in small amounts. The toxic dose for this dog is just 4 grams of bait. The common signs of toxicity were discussed. A recommendation was made to consider activated charcoal and to monitor arterial blood gases if possible or to use IV sodium bicarbonate if blood gas analysis is not available. The reporter was advised that methocarbamol is the drug of choice for managing tremors and diazepam, phenobarbital or pentobarbital may be used for seizures. A recommendation was made to collect baseline liver values as liver damage may occur 2-3 days after exposure. The use of liver protectants/antioxidants such as SAM-e and milk thistle may be considered. On follow up, the reporter stated that the dog was given activated charcoal, IV fluids, and pentothal. The reporter did not have access to IV methocarbamol. The dog's signs improved, but she died later that night. 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