Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-1953

2. Registrant Information.

Registrant Reference Number: Prosar 1-18626720

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-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

28-MAY-09

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/Snail Pellets MP (non-specific)

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

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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

Chihuahua/pekingese mixed breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

5

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

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.

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?

Other / Autre

specify Unknown if exposure occurred

17. Provide any additional details about the incident

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

1-18626720: A reporter (dog owner) called on 05/28/2009 to report the possible exposure of her dog to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the dog may have ingested the product anytime within the 24 hours prior to the report. At the time of the report the dog was having seizures, and the reporter was en route to the veterinarian. The reporter was advised that the product is highly toxic in small amounts, and animals with possible product exposure need to be seen by a veterinarian. The signs of product toxicity were reviewed. The reporter was encouraged to have the dog evaluated and treated by the veterinarian. The reporter was also encouraged to have the veterinarian draw blood to monitor liver values. On follow up, the reporter stated that the dog was seen by a veterinarian, but the veterinarian said the dog was "too far gone." No treatment was instituted and the dog died on 05/28/2009.

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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