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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6196

2. Registrant Information.

Registrant Reference Number: 194735

Registrant Name (Full Legal Name no abbreviations): Bell Laboratories, Inc.

Address: 3699 Kinsman Blvd

City: Madison

Prov / State: WI

Country: USA

Postal Code: 53704

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

Domestic Animal

4. Date registrant was first informed of the incident.

04-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

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.

Product Name: Tomcat Ultra Block Bait 12455-79-3240

  • Active Ingredient(s)
    • BROMADIOLONE
      • Guarantee/concentration .005 %

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. - In Home / Rés. - à l'int. maison

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Oral hemorrhage
  • General
    • Symptom - Biting
  • Nervous and Muscular Systems
    • Symptom - Lameness
    • Specify - dragging back legs

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Euthanised / Euthanasie

16. How was the animal exposed?

Other / Autre

specify There was no known exposure to the product.

17. Provide any additional details about the incident

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

6/4/2007 2:12:47 PMThe pet owner is calling to report that her dog is dragging her back legs and she is biting her lower abdomen and rectal area. The duration of these symptoms is unclear. The product was placed at 11 am this morning and there may be up to 2 ounces of the product missing. This dog has a history of anemia (caller does not know cause of anemia). No ingestion of product has been witnessed. The caller has 2 other small dogs in the home who may have also ingested the product. This product is an LAAC and the toxic dose for your symptomatic dog is 3.75 oz. The other two dogs would only have to ingest about 2-2.5 oz before treatment would definitely be recommended. This product does not cause acute paralysis in dogs. Because of your dog¿¿¿s geriatric status, history of anemia, and current symptoms, the dog should be evaluated by a DVM immediately. Also, we recommend that the small dogs are also taken to the vet since 2 oz of the product are missing. This product takes at least two days before symptoms would be visible. Given the short time frame, other causes for the dog¿¿¿s symptoms need to be considered. Symptoms of toxicity which may develop over the next 2-5 days include: difficulty breathing, lethargy, anorexia, ataxia, and evidence of bleeding in stool, urine, nasal secretions, and gums. An antidote, Vit K1, is available. Follow-up on 6/5/2007 from the pet owner: Caller stated that the dog was euthanized yesterday. Her veterinarian believes that the dog develop a ruptured disc in her back. The DVM also noted hemorrhaging of the gums and teeth. The owner elected not to treat the dog. The other two dogs remained asymptomatic and were not evaluated by her veterinarian as advised.


To be determined by Registrant

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

Death

19. Provide supplemental information here