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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-0236
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-35850077
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: 98054
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
28-DEC-135. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
Unknown
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 %
- METALDEHYDE
7. b) Type of formulation.
Granular
Application Information
8. Product was applied?
No
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
Blue Heeler
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Eye
- Symptom - Blindness (temporary)
- Nervous and Muscular Systems
- Symptom - Hallucination
- Symptom - Trembling
- Symptom - Other
- Specify - other "major neurologic problems" that the pet owner could not identify
- Gastrointestinal System
- Symptom - Gagging
- 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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-35850077 - The reporter, a pet owner, indicated that his dog was exposed to a molluscicide containing the active ingredient metaldehyde. At the time of the initial call, the reporter stated that his 1-year-old, Queensland Heeler dog chewed into the bag maybe one night earlier and at the time of the call the dog was having trouble seeing and was hallucinating. Immediate veterinary care was recommended. On follow-up call, two days later the reporter indicated that he called his veterinarian and was told not to bring the dog to the veterinary clinic as the veterinarian was concerned about transporting an animal that was running into things. The veterinarian recommended that the pet owner induce emesis at home. According to his veterinarians directions the reporter gave his dog two doses of 3 teaspoons of hydrogen peroxide but the dog did not vomit after either dose. The reporter then gave the dog an enema but they did not get anything out of the dogs system. Per the reporter the dog progressively declined; it was twitching violently, had other major neurologic problems was coughing and gagging and then passed away at home. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
