Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-2136

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-22364554

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: WA

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.

23-APR-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

23-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 8119-11-71376

Product Name: Maxide RTU Slug Snail Killer 3 lb

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

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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).

The product was applied to a garden. No other detail is available.

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

Cat / Chat

3. Breed

domestic long hair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.7

7. Weight (provide a range if necessary )

8

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

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Oral hemorrhage
  • Specify - bleeding from oral cavity

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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

1-22364554: The reporter (cat owner) called on 04/23/2010 to report suspected exposure of her cat to a pesticide containing the active ingredient Metaldehyde. The reporter had applied the product to her garden one week prior to the potential exposure. She reported she had let her 7 month 8 pound domestic long hair outside for one hour and had found the animal dead bleeding from its oral cavity. The caller had found a hole dug in an area where the product had been applied and suspects the animal had dug the hole. Exposure was suspected to be oral or dermal but no exposure was observed. The caller was advised the signs that may be observed following ingestion may include signs include dyspnea, hyperthermia, muscle spasms, locomotor signs, and seizures in severe cases. Bleeding from the oral cavity would be unexpected to occur following exposure.

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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