Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8684

2. Registrant Information.

Registrant Reference Number: 186011

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.

11-MAY-07

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

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. 12455-56

Product Name: Ditrac Tracking Powder12455-56

  • Active Ingredient(s)
    • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM SALT)
      • Guarantee/concentration .2 %

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: Unknown / Inconnu

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

Paint

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

1200

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
    • Symptom - Hemorrhage

12. How long did the symptoms last?

Unknown / Inconnu

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?

Other / Autre

specify There has been no known exposure to this product.

17. Provide any additional details about the incident

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

5/11/2007 5:55:12 PMThis morning caller found their mare dead, in rigor, and bleeding from every orifice. The horse lives with 4 other horses. The other horses are asymptomatic. They all eat from the same grain and hay sources. The only distinguishing event is that this mare received ivermectin at 0.6% the day before yesterday (mixed with grain). The horses live in an isolated population. BT bug spray was sprayed on the farm yesterday. Pasture is surrounded by oak + pine and contains no red maple trees and no clover. DVM sampled blood from live horses. No evidence of trauma. This rodenticide is used around the farm but it is only in places were the horses do not have access and there is no evidence that he horses have ingested this product. The caller is trying to rule out all possible cause of death and wants to know what would happen if the horses ate mice killed by the product. The toxic dose for a horse is 3-4 pounds (25-30 dead mice). It was recommended to stop feeding current grain and submit it for testing. Idiopathic thrombocytopenia is a possibility, which should be seen on the blood samples. The best post-mortem organ sample to test for diphacinone is liver. Anthrax is also a possibility. The local veterinarian should run PTs on the live horses. Don't move or touch the body until the lab determines if anthrax is present.


To be determined by Registrant

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

Death

19. Provide supplemental information here