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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-4225

2. Registrant Information.

Registrant Reference Number: 2015320

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: FLORIDA

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. 12455-129-3240

Product Name: Tomcat Mouse Killer III (refillable resistant bait station)

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

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.


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?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed


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

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms


  • Cardiovascular System
    • Symptom - Tachycardia
  • Eye
    • Symptom - Nystagmus
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - Opisthotonus
    • Symptom - Other
    • Specify - Moving slowly
    • Symptom - Ataxia
  • Respiratory System
    • Symptom - Respiratory distress
  • General
    • Symptom - Other
    • Specify - Hesitant to drink water
  • Gastrointestinal System
    • Symptom - Bloating
  • General
    • Symptom - Weakness

12. How long did the symptoms last?

Unknown / Inconnu

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


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?


Day(s) / Jour(s)

15. Outcome of the incident


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

4/2/2017 A pet owner reported that her dog ingested an unknown amount of product on the evening of 4/1/17. She found the 8 ounce bag of product on the floor with a hole chewed through it and bait scattered about the floor. Three ounces of product remained but she did not know how many blocks had been placed out for rodents. 24 hours post ingestion the dog began moving very slowly, seemed hesitant to drink water, developed a slightly bloated abdomen, and began passing indicator dye from the product in her feces. She was then taken to her veterinarian for treatment. Within 48 hours of hospitalization, the dog developed ataxia, nystagmus, and opisthotonous. The dog had a period of brief recovery but on the 3rd day of hospitalization developed abrupt weakness, tachycardia, respiratory distress, and died. While in the hospital the dog was treated with intravenous fluids, multiple doses of activated charcoal, mannitol, and intravenous lipid emulsion. No laboratory values were reported and it is not known if a necropsy was performed.

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.