Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-4962

2. Registrant Information.

Registrant Reference Number: 1847318

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.

19-JUN-16

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

18-JUN-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. 12455-123-3240

Product Name: Tomcat Mouse Killer II (pre-loaded resistant bait station)

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

---

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

8.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Death
  • Symptom - Vocalizing

• Nervous and Muscular Systems
  • Symptom - Other
  • Specify - Running around abnormally
  • Symptom - Difficulty getting up
  • Specify - Down animal, unable to rise

• Gastrointestinal System
  • Symptom - Fecal incontinence

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?

Unknown

15. Outcome of the incident

Died

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

6/19/2016 11:04:16 PM On June 18, 2016 between a local time of 5am to 6am, 5 adults Chihuahuas, 1 Cocker Spaniel, and possibly four 6-week-old Chihuahua puppies were exposed to an unknown number of Tomcat Mouse Killer II bait blocks. It appears that one or multiple dogs chewed through the sealed, unopened bag, and consumed all the bait from the bag. The caller stated yesterday morning (June 18) is when she discovered the exposure and found multiple piles of green stool on the floor and several piles of vomit. The caller stated Chihuahua 1, whom she expects ingested the largest amount of bait, began crying, running around, laid down, had vomiting episodes, and was defecating on herself until she eventually passed away on her own. The caller stated that Chihuahua 2, was not having any gastrointestinal signs but was unable to move his back legs and also passed away on his own. Chihuahua 3 became lethargic, was unable to use her hind legs, and had tremors. The caller stated she shot and killed this dog so that the pet would not suffer. The caller also stated she had a Cocker Spaniel who is suspected to have run away. The caller believes the pet likely ingested some of the rodent bait, but did not note any symptoms prior to the pet's disappearance. The caller has another Chihuahua, who has recently began having a vacant look to her eyes and seems weak. The caller also has a litters of 6 week old Chihuahua puppies, all which have distended abdomens and watery, vacant eyes. The caller has not noted any green bait in the stool of the puppies. The caller did not have the packaging from the chewed apart bag so an EPA number could not be obtained, but stated it contained the Tomcat Mouse Killer II. The caller does have a pre-loaded bait station, but that was not touched by the dogs. It was discussed with the caller that this product contains the Bromethalin and this bait works by causing swelling within the brain and when toxic doses are ingested we are likely to see signs between 2 to 24 hours following ingestion such as lethargy, ataxia, tremors, and seizures. Discussed that based on the size of her adult Chihuahuas each pet would only need to ingest about 1.5 tsp before a toxic dose has been consumed. Emergency medical evaluation for all remaining pets in the household was strongly recommended but declined by the pet owner who stated she would just monitor her pets at home.

---

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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

8.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Paralysis

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?

Unknown

15. Outcome of the incident

Died

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

6/19/2016 11:04:16 PM On June 18, 2016 between a local time of 5am to 6am, 5 adults Chihuahuas, 1 Cocker Spaniel, and possibly four 6-week-old Chihuahua puppies were exposed to an unknown number of Tomcat Mouse Killer II bait blocks. It appears that one or multiple dogs chewed through the sealed, unopened bag, and consumed all the bait from the bag. The caller stated yesterday morning (June 18) is when she discovered the exposure and found multiple piles of green stool on the floor and several piles of vomit. The caller stated Chihuahua 1, whom she expects ingested the largest amount of bait, began crying, running around, laid down, had vomiting episodes, and was defecating on herself until she eventually passed away on her own. The caller stated that Chihuahua 2, was not having any gastrointestinal signs but was unable to move his back legs and also passed away on his own. Chihuahua 3 became lethargic, was unable to use her hind legs, and had tremors. The caller stated she shot and killed this dog so that the pet would not suffer. The caller also stated she had a Cocker Spaniel who is suspected to have run away. The caller believes the pet likely ingested some of the rodent bait, but did not note any symptoms prior to the pet's disappearance. The caller has another Chihuahua, who has recently began having a vacant look to her eyes and seems weak. The caller also has a litter of 4, 6 week old Chihuahua puppies, all which have distended abdomens and watery, vacant eyes. The caller has not noted any green bait in the stool of the puppies. The caller did not have the packaging from the chewed apart bag so an EPA number could not be obtained, but stated it contained the Tomcat Mouse Killer II. The caller does have a pre-loaded bait station, but that was not touched by the dogs. It was discussed with the caller that this product contains bromethalin and this bait works by causing swelling within the brain and when toxic doses are ingested we are likely to see signs between 2 to 24 hours following ingestion such as lethargy, ataxia, tremors, and seizures. Discussed that based on the size of her adult Chihuahuas each pet would only need to ingest about 1.5 tsp before a toxic dose has been consumed. Emergency medical evaluation for all remaining pets in the household was strongly recommended but declined by the pet owner who stated she would just monitor her pets at home.

---

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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

8.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Muscle tremors
  • Symptom - Paralysis
  • Specify - unable to use back legs

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?

Unknown

15. Outcome of the incident

Euthanised / Euthanasie

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

6/19/2016 11:04:16 PM On June 18, 2016 between a local time of 5am to 6am, 5 adults Chihuahuas, 1 Cocker Spaniel, and possibly four 6-week-old Chihuahua puppies were exposed to an unknown number of Tomcat Mouse Killer II bait blocks. It appears that one or multiple dogs chewed through the sealed, unopened bag, and consumed all the bait from the bag. The caller stated yesterday morning (June 18) is when she discovered the exposure and found multiple piles of green stool on the floor and several piles of vomit. The caller stated Chihuahua 1, whom she expects ingested the largest amount of bait, began crying, running around, laid down, had vomiting episodes, and was defecating on herself until she eventually passed away on her own. The caller stated that Chihuahua 2, was not having any gastrointestinal signs but was unable to move his back legs and also passed away on his own. Chihuahua 3 became lethargic, was unable to use her hind legs, and had tremors. The caller stated she shot and killed this dog so that the pet would not suffer. The caller also stated she had a Cocker Spaniel who is suspected to have run away. The caller believes the pet likely ingested some of the rodent bait, but did not note any symptoms prior to the pet's disappearance. The caller has another Chihuahua, who has recently began having a vacant look to her eyes and seems weak. The caller also has a litters of 6 week old Chihuahua puppies, all which have distended abdomens and watery, vacant eyes. The caller has not noted any green bait in the stool of the puppies. The caller did not have the packaging from the chewed apart bag so an EPA number could not be obtained, but stated it contained the Tomcat Mouse Killer II. The caller does have a pre-loaded bait station, but that was not touched by the dogs. It was discussed with the caller that this product contains the Bromethalin and this bait works by causing swelling within the brain and when toxic doses are ingested we are likely to see signs between 2 to 24 hours following ingestion such as lethargy, ataxia, tremors, and seizures. Discussed that based on the size of her adult Chihuahuas each pet would only need to ingest about 1.5 tsp before a toxic dose has been consumed. Emergency medical evaluation for all remaining pets in the household was strongly recommended but declined by the pet owner who stated she would just monitor her pets at home.

---

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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.7

7. Weight (provide a range if necessary )

8.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Weakness

• Eye
  • Symptom - Other
  • Specify - Vacant look in the eyes

12. How long did the symptoms last?

Unknown / Inconnu

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?

Unknown

15. Outcome of the incident

Unknown/Inconnu

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

6/19/2016 11:04:16 PM On June 18, 2016 between a local time of 5am to 6am, 5 adults Chihuahuas, 1 Cocker Spaniel, and possibly four 6-week-old Chihuahua puppies were exposed to an unknown number of Tomcat Mouse Killer II bait blocks. It appears that one or multiple dogs chewed through the sealed, unopened bag, and consumed all the bait from the bag. The caller stated yesterday morning (June 18) is when she discovered the exposure and found multiple piles of green stool on the floor and several piles of vomit. The caller stated Chihuahua 1, whom she expects ingested the largest amount of bait, began crying, running around, laid down, had vomiting episodes, and was defecating on herself until she eventually passed away on her own. The caller stated that Chihuahua 2, was not having any gastrointestinal signs but was unable to move his back legs and also passed away on his own. Chihuahua 3 became lethargic, was unable to use her hind legs, and had tremors. The caller stated she shot and killed this dog so that the pet would not suffer. The caller also stated she had a Cocker Spaniel who is suspected to have run away. The caller believes the pet likely ingested some of the rodent bait, but did not note any symptoms prior to the pet's disappearance. The caller has another Chihuahua (subform 4), who has recently began having a vacant look to her eyes and seems weak. The caller also has a litters of 6 week old Chihuahua puppies, all which have distended abdomens and watery, vacant eyes. The caller has not noted any green bait in the stool of the puppies. The caller did not have the packaging from the chewed apart bag so an EPA number could not be obtained, but stated it contained the Tomcat Mouse Killer II. The caller does have a pre-loaded bait station, but that was not touched by the dogs. It was discussed with the caller that this product contains the Bromethalin and this bait works by causing swelling within the brain and when toxic doses are ingested we are likely to see signs between 2 to 24 hours following ingestion such as lethargy, ataxia, tremors, and seizures. Discussed that based on the size of her adult Chihuahuas each pet would only need to ingest about 1.5 tsp before a toxic dose has been consumed. Emergency medical evaluation for all remaining pets in the household was strongly recommended but declined by the pet owner who stated she would just monitor her pets at home.

---

To be determined by Registrant

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

Moderate

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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

4

5. Sex

Unknown

6. Age (provide a range if necessary )

0.02

7. Weight (provide a range if necessary )

Unknown

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 - Abdominal distension

• Eye
  • Symptom - Watery eye
  • Symptom - Other
  • Specify - Vacant look in the eyes

12. How long did the symptoms last?

Unknown / Inconnu

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?

Unknown

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify No known exposure.

17. Provide any additional details about the incident

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

6/19/2016 11:04:16 PM On June 18, 2016 between a local time of 5am to 6am, 5 adults Chihuahuas, 1 Cocker Spaniel, and possibly four 6-week-old Chihuahua puppies were exposed to an unknown number of Tomcat Mouse Killer II bait blocks. It appears that one or multiple dogs chewed through the sealed, unopened bag, and consumed all the bait from the bag. The caller stated yesterday morning (June 18) is when she discovered the exposure and found multiple piles of green stool on the floor and several piles of vomit. The caller stated Chihuahua 1, whom she expects ingested the largest amount of bait, began crying, running around, laid down, had vomiting episodes, and was defecating on herself until she eventually passed away on her own. The caller stated that Chihuahua 2, was not having any gastrointestinal signs but was unable to move his back legs and also passed away on his own. Chihuahua 3 became lethargic, was unable to use her hind legs, and had tremors. The caller stated she shot and killed this dog so that the pet would not suffer. The caller also stated she had a Cocker Spaniel who is suspected to have run away. The caller believes the pet likely ingested some of the rodent bait, but did not note any symptoms prior to the pet's disappearance. The caller has another Chihuahua, who has recently began having a vacant look to her eyes and seems weak. The caller also has a litters of 6 week old Chihuahua puppies, all which have distended abdomens and watery, vacant eyes. The caller has not noted any green bait in the stool of the puppies. The caller did not have the packaging from the chewed apart bag so an EPA number could not be obtained, but stated it contained the Tomcat Mouse Killer II. The caller does have a pre-loaded bait station, but that was not touched by the dogs. It was discussed with the caller that this product contains the Bromethalin and this bait works by causing swelling within the brain and when toxic doses are ingested we are likely to see signs between 2 to 24 hours following ingestion such as lethargy, ataxia, tremors, and seizures. Discussed that based on the size of her adult Chihuahuas each pet would only need to ingest about 1.5 tsp before a toxic dose has been consumed. Emergency medical evaluation for all remaining pets in the household was strongly recommended but declined by the pet owner who stated she would just monitor her pets at home.

---

To be determined by Registrant

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

Minor

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.