Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2763

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-22461712

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: WA

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.

01-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

01-MAY-10

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 and Snail Pellets MP

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

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7. b) Type of formulation.

Other (specify)

pellets

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 reporter indicated that his 3 dogs were in the same area as the product as it was being applied. There was no witnessed ingestion; ingestion is presumed.

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

Toy Poodle

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2.5

7. Weight (provide a range if necessary )

6

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Respiratory System
  • Symptom - Panting

• Nervous and Muscular Systems
  • Symptom - Shaking
  • Symptom - Difficulty walking
  • Specify - Could not walk
  • 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 No ingestion of the product was witnessed but the dog was in the same area during product application and ingestion is presumed.

17. Provide any additional details about the incident

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

1-22461712:The reporter, an animal owner, called on 5/1/10 to report the possible ingestion of a molluscicide containing the active ingredient Metaldehyde by his 3 dogs. No ingestion of the product was witnessed but the dogs were in the same area as the product during product application and ingestion was presumed. According to the reporter, the dogs may have ingested product 30-45 minutes prior to the call. One dog (1st subform III) had already developed symptoms (panting, unable to walk, and shaking) while the other two were still asymptomatic. The symptomatic dog was 6 weeks pregnant. During the call the toxic nature of the product was discussed including potential symptoms and their timeframe subsequent to exposure. The reporter was advised to immediately take all three dogs to a veterinarian. A follow-up call on 5/4/10 revealed that two of the dogs (1st and 3rd subform III) died later on the day of the call (5/1) after they developed seizures. The reporter could not afford veterinary care. The reporter induced emesis in one dog (2nd subform III), who then later developed seizures but recovered. The reporter was extremely upset, as the store he purchased the product from (name) had indicated the product was safe to use around dogs. During the follow-up call, it was discussed that liver damage may occur several days after exposure if a dog survived the acute phase. A recommendation was made to have a veterinarian evaluate the surviving dog.

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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

The store the reporter purchased the product from (name) had indicated the product was safe to use around dogs.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Toy Poodle

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

10

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 - Seizure

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify No ingestion of the product was witnessed but the dog was in the same area during product application and ingestion is presumed.

17. Provide any additional details about the incident

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

1-22461712: The reporter, an animal owner, called on 5/1/10 to report the possible ingestion of a molluscicide containing the active ingredient Metaldehyde by his 3 dogs. No ingestion of the product was witnessed but the dogs were in the same area as the product during product application and ingestion was presumed. According to the reporter, the dogs may have ingested product 30-45 minutes prior to the call. One dog (1st subform III) had already developed symptoms (panting, unable to walk, and shaking) while the other two were still asymptomatic. The symptomatic dog was 6 weeks pregnant. During the call the toxic nature of the product was discussed including potential symptoms and their timeframe subsequent to exposure. The reporter was advised to immediately take all three dogs to a veterinarian. A follow-up call on 5/4/10 revealed that two of the dogs (1st and 3rd subform III) died later on the day of the call (5/1) after they developed seizures. The reporter could not afford veterinary care. The reporter induced emesis in one dog (2nd subform III), who then later developed seizures but recovered. The reporter was extremely upset, as the store he purchased the product from (name) had indicated the product was safe to use around dogs. During the follow-up call, it was discussed that liver damage may occur several days after exposure if a dog survived the acute phase. A recommendation was made to have a veterinarian evaluate the surviving dog.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here

The store the reporter purchased the product from (name) had indicated the product was safe to use around dogs.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Toy Poodle

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

6

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 - 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 No ingestion of the product was witnessed but the dog was in the same area during product application and ingestion is presumed.

17. Provide any additional details about the incident

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

1-22461712: The reporter, an animal owner, called on 5/1/10 to report the possible ingestion of a molluscicide containing the active ingredient Metaldehyde by his 3 dogs. No ingestion of the product was witnessed but the dogs were in the same area as the product during product application and ingestion was presumed. According to the reporter, the dogs may have ingested product 30-45 minutes prior to the call. One dog (1st subform III) had already developed symptoms (panting, unable to walk, and shaking) while the other two were still asymptomatic. The symptomatic dog was 6 weeks pregnant. During the call the toxic nature of the product was discussed including potential symptoms and their timeframe subsequent to exposure. The reporter was advised to immediately take all three dogs to a veterinarian. A follow-up call on 5/4/10 revealed that two of the dogs (1st and 3rd subform III) died later on the day of the call (5/1) after they developed seizures. The reporter could not afford veterinary care. The reporter induced emesis in one dog (2nd subform III), who then later developed seizures but recovered. The reporter was extremely upset, as the store he purchased the product from (name) had indicated the product was safe to use around dogs. During the follow-up call, it was discussed that liver damage may occur several days after exposure if a dog survived the acute phase. A recommendation was made to have a veterinarian evaluate the surviving dog.

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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

The store the reporter purchased the product from (name) had indicated the product was safe to use around dogs.