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: 2015-6424

2. Registrant Information.

Registrant Reference Number: 1644269

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.

10-JUL-15

5. Location of incident.

Country: UNITED STATES

Prov / State: CALIFORNIA

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. 12455-120-3240

Product Name: Tomcat Mouse Killer I (refillable resistant bait station)

  • Active Ingredient(s)
    • BROMETHALIN
      • Guarantee/concentration .01 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Unknown

9. Application Rate.

Unknown

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

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

Dog / Chien

3. Breed

Border Collie

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

75.00

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

  • Blood
    • Symptom - Leukocytosis
  • Eye
    • Symptom - Pupil dilation
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Other
    • Specify - Infection in shoulder
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up
  • Respiratory System
    • Symptom - Difficulty Breathing
  • Nervous and Muscular Systems
    • Symptom - Recumbent
  • General
    • Symptom - Loss of voice
  • Gastrointestinal System
    • Symptom - Loss of appetite
    • Specify - decreased appetite

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?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify No witnessed or documented exposure.

17. Provide any additional details about the incident

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

On 7/10/2015 a pet owner reported that his 7 year old, 75 lb Border Collie became acutely ill, describing him as recumbent, unable to rise, having difficulty breathing with dilated pupils. The owner remarked that his tenant uses a lot of different rodenticides on the property and he suspects she is not using them safely (not securing them in bait stations). He did see a bag of this product on a table that his dog would have been able to reach although he does not know if the bag was disturbed. He also stated that he realized the dog may not have ingested the product. Immediate veterinary care was recommended due to the severity of the clinical signs. On 7/17/15 the pet owner called back to report his dog appeared to be recovering but had also began vomiting and developed a decreased appetite. He had not sought veterinary care. On 7/20/2015 the pet owner called back to report that he had found an empty container of this product and assumed his dog had ingested the bait. He also reported the dog continued to decline and was losing the ability to stand due to weakness. By this point, the dog had been examined by a veterinarian who thought the dog was suffering from a ruptured cancerous tumor or another etiology. She did not think the dog was suffering from bromethalin intoxication. The dog owner sought a second opinion and was told that his dog had a high white blood cell count and a possible shoulder infection secondary to a possible dog bite. On 7/26/15 the pet owner reported the dog had lost the ability to bark and had died at home. At some point prior to death, the dog had been examined by another veterinarian who had suspected the dog could also have an infection secondary to a dog bite. This veterinarian also did not suspect the dog was suffering from bromethalin intoxication.


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.