Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-2335

2. Registrant Information.

Registrant Reference Number: Prosar 1-18742085

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.

07-JUN-09

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

6. Date incident was first observed.

07-JUN-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: Corrys Slug/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

Unknown Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Seizure

• General
  • Symptom - Hyperthermia

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• 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

1-18742085: A reporter (dog owner) called on 06/07/2009 to report the exposure of his dog to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the product was ingested in the 2 hours prior to the report. At the time of the report, the dog was seizing. The reporter was advised that the product is highly toxic in small amounts and may result in signs like tremors and seizures. A recommendation was made to have the dog seen by a veterinarian immediately to decontaminate the dog and treat the signs. On follow up, the reporter stated that the dog was seen by a veterinarian and had a temperature of 109.6 degrees and muscle tremors. The dog died during treatment. 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