Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0550

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24924130

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.

09-DEC-10

5. Location of incident.

Country: UNITED STATES

Prov / State: HAWAII

6. Date incident was first observed.

09-DEC-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 4 lb

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

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

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

American Bulldog

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

48

lbs

8. Route(s) of exposure

Oral

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
  • Symptom - Shaking

• Gastrointestinal System
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Coma

• General
  • Symptom - Fever
  • 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?

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

1-24924130: The reporter, a pet owner, called on 12/9/10 indicating her 10 year old female American bulldog may have been exposed to a pesticide containing the active ingredient metaldehyde. The pet owner stated her dog got into a box of the product, which had accidentally been left on the patio. She may have ingested ¿ to 1 cup of product sometime during the evening on 12/8. The dog was asymptomatic when she was placed in her pen at 10 pm; however, when the owner went to let the dog outside the morning of 12/9 she found the dog was tremoring and seizuring. The dog was immediately taken to a veterinary clinic, where she was hospitalized. At the time of the call, the dog had also vomited, was comatose/unresponsive, was still having tremors and seizures, and had a fever. The veterinarian had given the dog a 50:50 chance of survival. During the call the reporter requested additional information about the product. The safety profile of the product was discussed, including symptoms and treatment for acute exposures. Recommendations were made to be sure and monitor the dog¿s liver values, since dogs surviving the acute phase may develop liver damage several days after exposure. A follow-up call on 12/10/10 revealed that the dog had died. The owner did not indicate whether the dog died on her own or was euthanized. No further information is available.

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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