Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2135

2. Registrant Information.

Registrant Reference Number: PROSAR 1-22356800

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.

22-APR-10

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

22-APR-10

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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 8119-11

Product Name: Corrys Slug and Snail Death

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

---

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10

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 - Fasciculations
  • 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?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

1-22356800: The reporter, an animal owner, notified the registrant on 4/22/10 of the exposure of a 4 year old dog to a pesticide product containing the active ingredient Metaldehyde. The dog had ingested an unknown quantity of product 10 minutes prior to the call. The reporter was advised of the highly toxic nature of the active ingredient, even in small amounts. A recommendation was made to seek immediate veterinary care. Follow-up the next day revealed that two dogs (both females) were involved in the exposure. Both were taken to a veterinarian, where decontamination on both animals was done via gastric lavage. The 4 year old dog subsequently developed tremors and seizures and had died while under veterinary care. The second dog remained asymptomatic and was due to be discharged at the time of the callback.

---

To be determined by Registrant

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

Death

19. Provide supplemental information here