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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6720

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15283356

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.


5. Location of incident.


Prov / State: CALIFORNIA

6. Date incident was first observed.


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.


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

Product Name: Corrys Slug + Snail Pellets MP - EPA: 8119-13

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

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Other / Autre

specify Unknown Exposure

17. Provide any additional details about the incident

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

History: Caller reporting the sudden death of her 7 year old Pomeranian weighing 16lbs. Believes the dog was exposed to the product, though no ingestion was witnessed. Product applied to a flowerbed / garden on 8-30-07, dog had access to the area, but caller denies presence of piles of the product nor that the dog would have had access to the container the product was in. Dog was placed in a pen on the night of 9-2-07, was found dead the night of 9-3-07. Dog was buried, no necropsy was performed, and caller does not wish to exhume her. Asking how long after the product is applied before it is considered safe for pets to be around, has a second dog who is currently ASX. Also expresses concern that "packaging needs to be more explicit that it is not safe for animals." Assessment: - For a small dog, even a small ingestion (2.5gm) could lead to SX that would be potentially fatal, however, would expect symptoms to develop within a few hours of ingestion. - Without access to piles of the product, would have been difficult for her to ingest enough to produce symptoms without hunting out the pellets where the product was applied. - Would not expect significant exposure to result from passing through the area where it was applied. - Will document concerns regarding labeling of the product. - Recommended restricting access to the area where the product was applied.

To be determined by Registrant

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


19. Provide supplemental information here