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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4689

2. Registrant Information.

Registrant Reference Number: Prosar 1-16724545

Registrant Name (Full Legal Name no abbreviations): Matson, LLC

Address: 45620 S. E. North Bend Way-PO Box 1820

City: North Bend

Prov / State: Washington

Country: USA

Postal Code: 98045

3. Select the appropriate subform(s) for the incident.


4. Date registrant was first informed of the incident.


5. Location of incident.



6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 8119-11-59144

Product Name: Eliminator Snail/Slug Bait II 3 lb

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

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - Out Home / Rés - à l'

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The product was applied 4 months prior to the report (06/--/2008). The time frame regarding product exposure and development of signs is unknown.

To be determined by Registrant

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


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

1. Source of Report.


2. Demographic information of data subject

Sex: Female

Age: Unknown / Inconnu

3. List all symptoms, using the selections below.


  • Skin
    • Symptom - Irritated skin
  • Blood
    • Symptom - Thrombocytopenia

4. How long did the symptoms last?

Unknown / Inconnu

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


6. a) Was the person hospitalized?


6. b) For how long?

7. Exposure scenario


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


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


10. Route(s) of exposure.



11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

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.)

1-16724545: A reporter called on 10/09/2008 to report the exposure of her sister-in-law to a slug and snail bait containing the active ingredient Metaldehyde. According to the reporter, the subject applied the product 4 months prior to the report (06/--/2008). During product application, the subject had dermal contact with the product on her feet and may have inhaled some of the product. At an unknown time following product application, the subject developed dermal irritation from her feet to her knees. The subject was seen by her physician (unknown date), and a complete blood count revealed thrombocytopenia. At the time of the report, the subject had persistent skin irritation and was scheduled to see a specialist regarding the thrombocytopenia. The reporter was advised that dermal contact with the product may result in skin irritation, but 4 months of persistent skin irritation is not expected. The reporter was also advised that dermal or minimal inhalation exposure to the product would not result in systemic toxicity. In addition, the product is not expected to cause thrombocytopenia. A recommendation was made to have the subject continue working with her physician to determine the cause and appropriate treatment for her signs. On follow up, it was reported that the subject was feeling fine and was on prednisone for one week after an evaluation with an oncologist. No further information was obtained.

To be determined by Registrant

14. Severity classification.


15. Provide supplemental information here.