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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0607

2. Registrant Information.

Registrant Reference Number: 1921335

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.

08-OCT-16

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

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. 12455-143-3240

Product Name: Tomcat with Bromethalin Place Pacs

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

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Schnauzer

4. Number of animals affected

4

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Drooling
  • Nervous and Muscular Systems
    • Symptom - Shaking

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

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

10/8/2016 11:28:30 AM The contents of 4 pound pail of product was placed under a rented mobile home on approximately October 1, 2016. The tenant has 12 dogs who were thought to have ingested an unknown amount of bait from beneath the mobile home. The dog owner has seen evidence the product indicator dye in dog feces in her yard but does not know exactly which dogs ingested the product. One dog died on Oct 7, 2016 after exhibiting anorexia, malaise, shaking, and loss of her hind limbs. This do was seen by a veterinarian the morning of Oct 7, given fluids (unknown route), antibiotics, and other unspecified treatments. Blood work was performed but the pet owner did not know the results. The veterinarian did not appear to have provided a diagnosis but advised the owner the dogs prognosis was grave. This dog had a history of developing hypocalcemia while pregnant and weaned puppies a few weeks prior to death. Three additional dogs are symptomatic, the first of which is exhibiting drooling, anorexia, and shaking. The second dog is reportedly acting funny (interpreted as malaise) and does not appear to hear when you talk to her; she is also depressed, won't hold her head up very often, is yawning, and licking at her mouth frequently. The third dog, which is also pregnant, has exhibited dry-heaving and is acting very timid and scared which is abnormal. Neither the pet owner nor landlord could immediately identify the product used as the pail/container had been thrown away. The landlord returned to the place of purchase and believes this is the product she originally purchased.


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

Miniature Schnauzer

4. Number of animals affected

4

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Licking
    • Specify - Licking lips
    • Symptom - Other
    • Specify - Yawning
    • Symptom - Malaise
  • Nervous and Muscular Systems
    • Symptom - Depression
    • Symptom - Abnormal posture
    • Specify - Will not hold head up often
  • Ear
    • Symptom - Other
    • Specify - Does not appear to hear when you talk to her

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

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

10/8/2016 11:28:30 AM The contents of 4 pound pail of product was placed under a rented mobile home on approximately October 1, 2016. The tenant has 12 dogs who were thought to have ingested an unknown amount of bait from beneath the mobile home. The dog owner has seen evidence the product indicator dye in dog feces in her yard but does not know exactly which dogs ingested the product. One dog died on Oct 7, 2016 after exhibiting anorexia, malaise, shaking, and loss of her hind limbs. This do was seen by a veterinarian the morning of Oct 7, given fluids (unknown route), antibiotics, and other unspecified treatments. Blood work was performed but the pet owner did not know the results. The veterinarian did not appear to have provided a diagnosis but advised the owner the dogs prognosis was grave. This dog had a history of developing hypocalcemia while pregnant and weaned puppies a few weeks prior to death. Three additional dogs are symptomatic, the first of which is exhibiting drooling, anorexia, and shacking. The second dog is reportedly acting funny (interpreted as malaise) and does not appear to hear when you talk to her; she is also depressed, won't hold her head up very often, is yawning, and licking at her mouth frequently. The third dog, which is also pregnant, has exhibited dry-heaving and is acting very timid and scared which is abnormal. Neither the pet owner nor landlord could immediately identify the product used as the pail/container had been thrown away. The landlord returned to the place of purchase and believes this is the product she originally purchased.


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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Schnauzer

4. Number of animals affected

4

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Retching
  • General
    • Symptom - Abnormal behaviour
    • Specify - scared

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

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

10/8/2016 11:28:30 AM The contents of 4 pound pail of product was placed under a rented mobile home on approximately October 1, 2016. The tenant has 12 dogs who were thought to have ingested an unknown amount of bait from beneath the mobile home. The dog owner has seen evidence the product indicator dye in dog feces in her yard but does not know exactly which dogs ingested the product. One dog died on Oct 7, 2016 after exhibiting anorexia, malaise, shaking, and loss of her hind limbs. This do was seen by a veterinarian the morning of Oct 7, given fluids (unknown route), antibiotics, and other unspecified treatments. Blood work was performed but the pet owner did not know the results. The veterinarian did not appear to have provided a diagnosis but advised the owner the dogs prognosis was grave. This dog had a history of developing hypocalcemia while pregnant and weaned puppies a few weeks prior to death. Three additional dogs are symptomatic, the first of which is exhibiting drooling, anorexia, and shacking. The second dog is reportedly acting funny (interpreted as malaise) and does not appear to hear when you talk to her; she is also depressed, won't hold her head up very often, is yawning, and licking at her mouth frequently. The third dog, which is also pregnant, has exhibited dry-heaving and is acting very timid and scared which is abnormal. Neither the pet owner nor landlord could immediately identify the product used as the pail/container had been thrown away. The landlord returned to the place of purchase and believes this is the product she originally purchased.


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.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Schnauzer

4. Number of animals affected

4

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Drooling
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Difficulty getting up
    • Specify - Loss of use of hind limbs
    • Symptom - Shaking
  • General
    • Symptom - Malaise

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

10/8/2016 11:28:30 AM The contents of 4 pound pail of product was placed under a rented mobile home on approximately October 1, 2016. The tenant has 12 dogs who were thought to have ingested an unknown amount of bait from beneath the mobile home. The dog owner has seen evidence the product indicator dye in dog feces in her yard but does not know exactly which dogs ingested the product. One dog died on Oct 7, 2016 after exhibiting anorexia, malaise, shaking, and loss of use of her hind limbs. This do was seen by a veterinarian the morning of Oct 7, given fluids (unknown route), antibiotics, and other unspecified treatments. Blood work was performed but the pet owner did not know the results. The veterinarian did not appear to have provided a diagnosis but advised the owner the dogs prognosis was grave. This dog had a history of developing hypocalcemia while pregnant and weaned puppies a few weeks prior to death. Three additional dogs are symptomatic, the first of which is exhibiting drooling, anorexia, and shacking. The second dog is reportedly acting funny (interpreted as malaise) and does not appear to hear when you talk to her; she is also depressed, won't hold her head up very often, is yawning, and licking at her mouth frequently. The third dog, which is also pregnant, has exhibited dry-heaving and is acting very timid and scared which is abnormal. Neither the pet owner nor landlord could immediately identify the product used as the pail/container had been thrown away. The landlord returned to the place of purchase and believes this is the product she originally purchased.


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.