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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1018

2. Registrant Information.

Registrant Reference Number: 265330

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.

28-NOV-07

5. Location of incident.

Country: UNITED STATES

Prov / State: VIRGINIA

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: Fastrac (non-specific)

  • Active Ingredient(s)
    • BROMETHALIN

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Pinscher

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

9

7. Weight (provide a range if necessary )

15.00

lbs

8. Route(s) of exposure

Oral

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

  • Blood
    • Symptom - Bleeding
  • General
    • Symptom - Death
  • Skin
    • Symptom - Bruises

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?

Yes

14. b) How long was the animal hospitalized?

1

Hour(s) / Heure(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown route of exposure

17. Provide any additional details about the incident

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

11/28/2007 10:04:07 AMThe caller is a veterinary technician's assistant. A client presented today with three dogs. Dog #1 was found dead at home that morning. The client observed bruising on the dog and blood coming from its mouth. However, the dog did bite his tongue prior to death. The client has two other dogs in the home that are asymptomatic. She does not known whether or not the dogs ingested any of the product but she admits to using the Fastrac product around her home. No direct exposure to the product was witnessed. The caller was informed that this active ingredient causes cerebral edema in mammals and that it was not a vitamin K antagonist. Despite this information, the two asymptomatic dogs were given injections of Vitamin K 1 and sent home on oral Vitamin K 1. The other two dogs remained asymptomatic.


To be determined by Registrant

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

Death

19. Provide supplemental information here

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.