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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2964

2. Registrant Information.

Registrant Reference Number: Prosar 1-19330042

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.

28-JUL-09

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

28-JUL-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. Unknown

Product Name: "Ready to Use" Slug and Snail Killer

  • Active Ingredient(s)
    • METALDEHYDE
      • Unknown

7. b) Type of formulation.

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 2 days prior to the call (estimated 7/26/09).

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

Siberian Husky

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

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

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Subdued
    • Specify - Withdrawn
  • Gastrointestinal System
    • Symptom - Salivating excessively
    • Symptom - Anorexia
  • Respiratory System
    • Symptom - Heavy breathing
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

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?

Other / Autre

specify There was no witnessed ingestion; the owner thought the dog may have been exposed sometime within the previous 24 hours.

17. Provide any additional details about the incident

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

1-19330042: The reporter, the animal¿s owner, called on 7/28/09 to report the possible exposure of her Siberian Husky to a Metaldehyde based slug and snail product. According to the reporter, she had applied the product about 2 days prior to the call. The reporter believed the dog may have ingested product within the previous 24 hours. At the time of the call the dog was withdrawn, vomiting, salivating, anorexic, and breathing heavily. The product¿s toxicity profile was discussed including the rapid onset of associated symptoms. A recommendation was made to have the dog evaluated by a veterinarian ASAP. A follow-up call on 7/29/09 revealed that the dog had been seen by a veterinarian the same day as the call. The veterinarian felt nothing could be done for the dog, and the dog passed away at home the morning of 7/29.


To be determined by Registrant

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

Death

19. Provide supplemental information here