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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-1225

2. Registrant Information.

Registrant Reference Number: 271500

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.


5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

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. 27191      PMRA Submission No.       EPA Registration No.

Product Name: Tomcat Ultra (non-specific)

  • Active Ingredient(s)

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).

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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Blood
    • Symptom - Bleeding
  • Cardiovascular System
    • Symptom - Tachycardia
  • Respiratory System
    • Symptom - Tachypnea
    • Symptom - Coughing
  • Skin
    • Symptom - Pallor
  • Nervous and Muscular Systems
    • Symptom - Lameness
  • Cardiovascular System
    • Symptom - Other
    • Specify - Pericardial effusion

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


Day(s) / Jour(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

12/17/2007 7:56:44 PMThe pet owners states that they are on the way to the veterinarian as the dog has ingested an unknown amount of the product about 1 week ago. The dog is exhibiting bleeding along her paws, coughing up blood, having labored breathing, and limping. The owner believes the dog ingested the product on week ago. She no longer has the packaging but believes the name of the product was Tomcat. She went on-line and found, what she assumes, was the product that she had purchased. 12/17/2007 9:38:34 PMThe veterinarian called to report that the dog has very pale mucus membranes, is tachycardic, tachypnic, has muffled heart sounds, and is coughing up blood. They have not yet run laboratory tests. 1/3/2008 4:18:17 PMUpon follow-up, the owner states the dog was hospitalized for a 2 days, given Vitamin K1 Injections, and had monitored clotting times. No transfusions were done. The dog is currently asymptomatic. There was no mention of whether or not the dog was discharged with oral Vitamin K.

To be determined by Registrant

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


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.