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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3149

2. Registrant Information.

Registrant Reference Number: PROSAR CASE#: 1-22911471

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.

06-JUN-10

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

06-JUN-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. 8119-13-71376

Product Name: Easy Gone Slug Snail Killer Mini Pellets

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

7. b) Type of formulation.

Other (specify)

pellet

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

Mixed breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.66

7. Weight (provide a range if necessary )

20

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

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Foaming at mouth
  • Nervous and Muscular Systems
    • Symptom - Shaking

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 Unknown, the reporter did not specify

17. Provide any additional details about the incident

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

1-22911471- The reporter, a pet owner, called to indicate exposure of his animal to a pesticide containing the active ingredient metaldehyde. The reporter indicated his animal, an 8 month 20 pound female mixed breed dog, had ingested an unknown amount of the product within one hour of the initial contact with the registrant. It remained unspecified whether exposure had occurred secondary to accidentally access to the container or access to application areas. The animal was reported to have been shaking, panting and foaming at the mouth at the initial contact. The pet owner was advised to seek immediate veterinary care for the animal and of standard treatment protocols including decontamination following domestic animal ingestion of this active ingredient. On routine call back the registrant was informed the animal had died. The pet owner had contacted a veterinarian by phone and was turned away by the veterinarian. The pet owner stated the veterinarian had indicated nothing could be done for the animal. This opinion would not conform to current veterinary emergency and critical care standards of care.


To be determined by Registrant

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

Death

19. Provide supplemental information here