Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2334

2. Registrant Information.

Registrant Reference Number: Prosar 1-18710113

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.

04-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

6. Date incident was first observed.

29-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. 8119-11

Product Name: Corry's Slug and Snail Death (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

Miniature Schnauzer

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

20

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

• Nervous and Muscular Systems
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

• Liver
  • Symptom - Other
  • Specify - "Liver was poisoned"

• 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?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

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

1-18710113: A reporter (dog owner) called on 06/04/2009 to report the possible exposure of her dog to a snail and slug bait containing the active ingredient Metaldehyde. According to the reporter, the dog was found outside on 05/29/2009 seizing and having vomiting and diarrhea. It is unknown whether she ingested the product. The dog was taken to the veterinarian and hospitalized on IV fluids and "vitamins". It is unknown what other treatments were administered. The seizures could not be controlled and the veterinarian indicated that the dog's "liver had been poisoned." The dog died on 05/30/2009. The reporter wanted to know what signs are seen with ingestion of the product, what treatments are recommended and whether something should be added to the product to deter ingestion. The reporter was advised that the product is highly toxic in small amounts and may result in symptoms including vomiting, diarrhea, tremors, incoordination, seizures, and death. With any possible ingestion of the product, immediate veterinary evaluation is required to achieve decontamination. After decontamination, activated charcoal is recommended. Further treatment is aimed at managing signs including controlling tremors and seizures. The reporter was also advised that dogs may develop liver damage 2-3 after exposure so baseline liver values should be determined and then rechecked in 3-4 days. The reporter was advised that the product does contain a bittering agent that is intended to deter ingestion. No further information was obtained.

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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