Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1754

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16110134

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.

Human

4. Date registrant was first informed of the incident.

06-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

6. Date incident was first observed.

28-APR-08

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 and Snail Death 2 lb.

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

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7. b) Type of formulation.

Bait

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 reporter applied the product on 4/24 or 4/25/08.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Skin
  • Symptom - Rash
  • Symptom - Hives
  • Symptom - Itchy skin

• Respiratory System
  • Symptom - Difficulty Breathing

4. How long did the symptoms last?

Unknown / Inconnu

5. Was medical treatment provided? Provide details in question 13.

Yes

6. a) Was the person hospitalized?

Yes

6. b) For how long?

Unknown

7. Exposure scenario

Unknown

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

>24 hrs <=3 days / >24 h <=3 jours

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-16110134: The reporter called on 5/6/08 to report she had developed a rash 3-4 days after she had applied a slug and snail bait containing the active ingredient Metaldehyde. She had first noticed a rash on 4/28/08, and had applied the product on 4/24 or 4/25/08. She had spoken with her physician about the rash on 4/28/08 and he had suggested a possible contact dermatitis. By the time of the 5/6 call, the rash had progressed to pruritic hives/welts. The reporter inquired about dermatological affects related to the product, as she had remembered inhaling some of the dust while applying the product. The safety profile of the product was discussed (No expected dermatologic symptoms). A follow-up call on 5/14/08 revealed the reporter had been admitted to an ICU on 5/11 with breathing difficulties, but was expected to be discharged soon. Her symptoms had been diagnosed as being possibly related to a bronchial infection; the product was not suspected.

To be determined by Registrant

14. Severity classification.

Major

15. Provide supplemental information here.