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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2091

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-26006075

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.

29-APR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

26-APR-11

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

Product Name: Corrys Slug Snail Pellets MP

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

7. b) Type of formulation.

Bait

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

Aust Shepherd (Aussie)

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

42

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

  • General
    • Symptom - Death
    • Symptom - Hyperthermia

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-26006075- The reporter, a pet owner, calls to indicate her animal may have been exposed to a pesticide containing the active ingredient metaldehyde. The pet owner indicated her five year forty two pound Australian shepherd was found dead three days prior to her initial contact with the registrant. The pet owner indicated her animal¿s remains were brought to her veterinarian and a body temperature was found to be 107 F. Based on this facet the veterinarian had posited the animal may have had a seizure prior to its death, but no seizure activity was observed. The pet owner stated a necropsy had been performed on the animal and failed to note any significant findings or identify a cause of death. The pet owner states there was no known exposure to the product, no evidence of disturbed product, and no bait was found in the animal¿s alimentary canal on necropsy. The pet owner had indicated she was having a difficult time coping with the ambiguity surrounding the animal¿s death. The pet owner was advised of the magnitude of product necessary to incite signs. It was noted the necropsy would have likely discovered evidence of the product in the digestive tract if ingested. The pet owner was advised she may request further tissue analysis for the active ingredient which may be available dependent on her diagnostic labs capabilities. The caller seemed unlikely to pursue the diagnosis much further. No further information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here