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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-1594
2. Registrant Information.
Registrant Reference Number: Prosar 1-18274271
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.
28-APR-095. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
13-APR-09Product 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. 8119-11
Product Name: Corrys Slug/Snail Death (non-specific)
- Active Ingredient(s)
- METALDEHYDE
- Guarantee/concentration 3.25 %
- METALDEHYDE
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
Labrador Retriever
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
2.5
7. Weight (provide a range if necessary )
70
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- 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?
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
1-18274271: A reporter called on 04/28/2009 to report the exposure of his three dogs to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the three dogs got into a box of product on 04/13/2009. All three dogs developed seizures at an unknown time following product ingestion. The dogs were evaluated by a veterinarian. Dog #1 (1st Subform III) died on an unknown date. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) recovered after an unknown period of time and with unknown treatment. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Labrador Retriever
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
2.5
7. Weight (provide a range if necessary )
70
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
12. How long did the symptoms last?
Unknown / Inconnu
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
Fully Recovered / Complètement rétabli
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
1-18274271: A reporter called on 04/28/2009 to report the exposure of his three dogs to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the three dogs got into a box of product on 04/13/2009. All three dogs developed seizures at an unknown time following product ingestion. The dogs were evaluated by a veterinarian. Dog #1 (1st Subform III) died on an unknown date. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) recovered after an unknown period of time and with unknown treatment. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Boxer
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
1.5
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Oral
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
12. How long did the symptoms last?
Unknown / Inconnu
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
Fully Recovered / Complètement rétabli
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
1-18274271: A reporter called on 04/28/2009 to report the exposure of his three dogs to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the three dogs got into a box of product on 04/13/2009. All three dogs developed seizures at an unknown time following product ingestion. The dogs were evaluated by a veterinarian. Dog #1 (1st Subform III) died on an unknown date. Dog #2 (2nd Subform III) and Dog #3 (3rd Subform III) recovered after an unknown period of time and with unknown treatment. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
