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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-4224

2. Registrant Information.

Registrant Reference Number: 2015115

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.

02-APR-17

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

6. Date incident was first observed.

01-APR-17

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. 12455-132-3240

Product Name: Tomcat with Bromethalin Bait Chunx

  • 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

Horse / Cheval

3. Breed

Unknown

4. Number of animals affected

2

5. Sex

Male

6. Age (provide a range if necessary )

20

7. Weight (provide a range if necessary )

1100

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

  • General
    • Symptom - Death
  • Renal System
    • Symptom - Renal failure
  • Nervous and Muscular Systems
    • Symptom - Restlessness
  • General
    • Symptom - Abnormal behaviour
    • Symptom - Other
    • Specify - Persistent stretching
    • Symptom - Abnormal behaviour
    • Specify - Cycles of standing up and laying down

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 Speculated ingestion, no witnessed or known exposure. Owner speculated that rodents dragged bait into a water source.

17. Provide any additional details about the incident

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

4/2/2017 9:08:20 AM Caller is not certain that his animals got a hold of the product, however they have both exhibited symptoms starting over the course of the last 24 hours. Caller is worried that, after he applied half the pail of the product, a rodent may have dragged some of it into a water source, causing the horses to possibly ingest it. A 20 year old began to experience symptoms of significant restlessness, which caller describes as cycles of standing up and laying down along with persistent stretching, that was first noticed on 4/1/17. The horse was evaluated by a veterinarian and it was concluded that the horse was in kidney failure, cause unknown. The horse was given fluids in an attempt to treat the issue, however the symptoms persisted until the horses death on the morning April 2, 2017. A second horse, approximately 1 year old, also began displaying signs of significant restlessness, which caller describes as cycles of standing up and laying down. This began on April 2 and persisted to the time of the report. No treatments had been attempted for this animal as of the report.


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

Horse / Cheval

3. Breed

Unknown

4. Number of animals affected

2

5. Sex

Male

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

700.00

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

  • Nervous and Muscular Systems
    • Symptom - Restlessness
  • General
    • Symptom - Abnormal behaviour
    • Specify - Cycles of standing up and laying down

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?

Other / Autre

specify Speculated ingestion, no witnessed or known exposure.

17. Provide any additional details about the incident

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

4/2/2017 9:08:20 AM Caller is not certain that his animals got a hold of the product, however they have both exhibited symptoms starting over the course of the last 24 hours. Caller is worried that, after he applied half the pail of the product, a rodent may have dragged some of it into a water source, causing the horses to possibly ingest it. A 20 year old began to experience symptoms of significant restlessness, which caller describes as cycles of standing up and laying down along with persistent stretching, that was first noticed on 4/1/17. The horse was evaluated by a veterinarian and it was concluded that the horse was in kidney failure, cause unknown. The horse was given fluids in an attempt to treat the issue, however the symptoms persisted until the horseżżżżżżs death on the morning April 2, 2017. A second horse, approximately 1 year old, also began displaying signs of significant restlessness, which caller describes as cycles of standing up and laying down. This began on April 2 and persisted to the time of the report. No treatments had been attempted for this animal as of the report.


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.