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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-2661

2. Registrant Information.

Registrant Reference Number: 1761968

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.


Prov / State: TENNESSEE

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.       PMRA Submission No.       EPA Registration No. 12455-101

Product Name: Talpirid Mole Bait

  • Active Ingredient(s)
      • Guarantee/concentration .025 %

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

Jack Russell Terrier

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?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Lethargy
    • Symptom - Polydipsia

12. How long did the symptoms last?

Persisted until death

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


15. Outcome of the incident


16. How was the animal exposed?

Other / Autre

specify Speculated exposure, no known exposure.

17. Provide any additional details about the incident

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

1/27/2016 3:29:19 PM Caller states one of her 4 dogs died unexpectedly last night and she would like information regarding the product. Her lawn service placed an unknown amount of the product in multiple mole holes in her yard over the summer and she would like to know if it would still be considered toxic. The lawn service told her dogs are not attracted to the product and wouldn't seek it out; however her dogs dig holes in the yard daily and it is unknown if any of them ingested the product. On 1/24/2016, her dog began projectile vomiting, was drinking more than usual and would not eat. There was no blood in the vomit. On 1/25/2016 the dog was evaluated by her veterinarian; bloodwork and radiographs were normal. It is not known what therapies he received while he was there, except for subcutaneous fluids. He continued to decline; he was very lethargic and anorexic. Last night the caller brought him to an emergency hospital where he passed away. The caller elected to have a necropsy performed and the results are pending. After learning how the active ingredient works and that the product is a neurotoxin, she no longer thinks her dog's death is related to the product. She stated he did not show any neurological signs.

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.