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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-4960

2. Registrant Information.

Registrant Reference Number: 1827417

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.

23-MAY-16

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

22-MAY-16

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. 12455-101-3240

Product Name: Tomcat Mole Killer Grubs

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

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Mastiff

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

150.00

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

  • Gastrointestinal System
    • Symptom - Loss of appetite
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Trembling
    • Symptom - Difficulty getting up

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify The product was on the property when the dog died but there was no evidence of ingestion or exposure.

17. Provide any additional details about the incident

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

5/23/2016 10:18:37 AM A veterinarian reported a fatality in a clients dog. Per the client, her Mastiff dropped dead on 5/22/16. Prior to death, the dog exhibited a reduced appetite, trembling, and difficulty rising for 1 days duration. The client/pet owner stated that this product was on their property although they are unaware of the dog having any access to the product and there was no witnessed exposure to the product. The veterinarian does not think the product caused the death of the dog and suspects, especially because of its geriatric status, other causes of death are much more likely. Regardless, she told the pet owner that she would report the event and inquire about what the clinical signs of intoxication would be. The owner declined a necropsy on the dog so the cause of death will remain unknown. The veterinarian was advised that a dog of this size would need to ingest approximately 27 grubs before toxicity would be expected. The product causes neurological signs and may result in cerebral edema within 24 hours of toxic exposure. This dog would need to ingest multiple packages of the product for toxicity concerns to exist. The product should be kept well away from any pets.


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.