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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2764

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-22557146

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.

08-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

08-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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

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

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

7. b) Type of formulation.

Other (specify)

pellets

Application Information

8. Product was applied?

Unknown

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

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

Bichon Frise

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.58

7. Weight (provide a range if necessary )

15

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Fasciculations
  • 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-22557146: The reporter, an animal owner, calls 05/08/10 to report exposure of her dog to a pesticide containing the active ingredient Metaldehyde. The caller initially reports her 7 month 15 pound Bichon Frise (sub form III #1) had ingested an unknown amount of the product 20 minutes before the call. The animal was demonstrating tremors or fasciculations at the time of the call. The owner was advised to seek prompt veterinary care as the primary thrust of treatment is aggressive decontamination following ingestion. The caller was advised of symptoms typically seen following ingestion, supportive measures, and to have the veterinarian monitor liver values following ingestion. On routine call back the animal owner indicated she sought veterinary care for the animal (sub form III #1) but that it died. She did not specify treatments or if the animal was hospitalized. The caller further indicated at this point that two additional dogs were exposed that she had not mentioned at her initial call. A 6 month dog of unspecified breed (sub form III #2) had an unspecified exposure. The animal had developed neurologic symptoms that the owner did not clarify and had fallen into their pool and died. This occurred at home while the owner was at the veterinarian¿s office. The third animal (sub form III #3) a 25 pound cocker spaniel also had an unspecified exposure, developed hind limb fasciculations that resolved spontaneously after an unknown duration, and required no care.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

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

  • Nervous and Muscular Systems
    • Symptom - Fasciculations
  • 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-22557146: The reporter, an animal owner, calls 05/08/10 to report exposure of her dog to a pesticide containing the active ingredient Metaldehyde. The caller initially reports her 7 month 15 pound Bichon Frise (sub form III #1) had ingested an unknown amount of the product 20 minutes before the call. The animal was demonstrating tremors or fasciculations at the time of the call. The owner was advised to seek prompt veterinary care as the primary thrust of treatment is aggressive decontamination following ingestion. The caller was advised of symptoms typically seen following ingestion, supportive measures, and to have the veterinarian monitor liver values following ingestion. On routine call back the animal owner indicated she sought veterinary care for the animal (sub form III #1) but that it died. She did not specify treatments or if the animal was hospitalized. The caller further indicated at this point that two additional dogs were exposed that she had not mentioned at her initial call. A 6 month dog of unspecified breed (sub form III #2) had an unspecified exposure. The animal had developed neurologic symptoms that the owner did not clarify and had fallen into their pool and died. This occurred at home while the owner was at the veterinarian¿s office. The third animal (sub form III #3) a 25 pound cocker spaniel also had an unspecified exposure, developed hind limb fasciculations that resolved spontaneously after an unknown duration, and required no care.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

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 )

Unknown

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 - Fasciculations

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-22557146: The reporter, an animal owner, calls 05/08/10 to report exposure of her dog to a pesticide containing the active ingredient Metaldehyde. The caller initially reports her 7 month 15 pound Bichon Frise (sub form III #1) had ingested an unknown amount of the product 20 minutes before the call. The animal was demonstrating tremors or fasciculations at the time of the call. The owner was advised to seek prompt veterinary care as the primary thrust of treatment is aggressive decontamination following ingestion. The caller was advised of symptoms typically seen following ingestion, supportive measures, and to have the veterinarian monitor liver values following ingestion. On routine call back the animal owner indicated she sought veterinary care for the animal (sub form III #1) but that it died. She did not specify treatments or if the animal was hospitalized. The caller further indicated at this point that two additional dogs were exposed that she had not mentioned at her initial call. A 6 month dog of unspecified breed (sub form III #2) had an unspecified exposure. The animal had developed neurologic symptoms that the owner did not clarify and had fallen into their pool and died. This occurred at home while the owner was at the veterinarian¿s office. The third animal (sub form III #3) a 25 pound cocker spaniel also had an unspecified exposure, developed hind limb fasciculations that resolved spontaneously after an unknown duration, and required no care.


To be determined by Registrant

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

Minor

19. Provide supplemental information here