Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2428

2. Registrant Information.

Registrant Reference Number: PROSAR case: 1-40754058

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-MAY-15

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

29-MAY-15

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. 8119-5

Product Name: Deadline Bug Bait

• Active Ingredient(s)
  • CARBARYL
    • Guarantee/concentration 5 %
  • METALDEHYDE
    • Guarantee/concentration 2 %

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7. b) Type of formulation.

Bait

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).

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

Other / Autre

specify Turtle

3. Breed

Red Eared Slider

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

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

• Respiratory System
  • Symptom - Laboured breathing
  • Specify - Gasping for air

• General
  • Symptom - Abnormal behaviour
  • Specify - Doesn't want to go in the water
  • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-40754058 - The reporter, a pet owner, indicated that her turtle was exposed to an insecticide containing the active ingredients metaldehyde and carbaryl. The product was applied in the yard one day prior to initial contact with the registrant and on the day of initial contact the reporters red eared slider turtle was allowed in the yard and had access to the application site. No exposure to the product was witnessed but when the reporter found the turtle it was gasping for air and it did not want to go into the water. The reporter was advised to seek immediate medical attention. On follow-up call, four days later, the reporter indicated that the turtle passed away the next day. They had tried changing the turtles water a couple of times but it didnt help. No veterinary care was sought. 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