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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-0502

2. Registrant Information.

Registrant Reference Number: 2137989

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.

07-NOV-17

5. Location of incident.

Country: UNITED STATES

Prov / State: MINNESOTA

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. Unknown

Product Name: Jaguar (non-specific)

  • Active Ingredient(s)
    • BRODIFACOUM
      • Guarantee/concentration .005 %

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

Mixed Breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

25.00

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

  • Blood
    • Symptom - Bleeding
    • Symptom - Hyperglycemia
    • Symptom - Thrombocytopenia
  • General
    • Symptom - Hypothermia
    • Symptom - Pain
  • Liver
    • Symptom - Elevated liver enzymes
  • Blood
    • Symptom - Other
    • Specify - Activated clotting time prolonged
    • Symptom - Other
    • Specify - Elevated reticulocytes
    • Symptom - Other
    • Specify - elevated blood urea nitrogen
    • Symptom - Hyperphosphatemia
  • Respiratory System
    • Symptom - Difficulty Breathing
  • Gastrointestinal System
    • Symptom - Other
    • Specify - Abdominal fluid wave
  • Nervous and Muscular Systems
    • Symptom - Stiffness
    • Symptom - Other
    • Specify - stiff gait

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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 exposure to pesticide

17. Provide any additional details about the incident

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

11/7/2017 10:42:14 AM A veterinarian reported they were currently treating a dog (Patient 1) which was presented to the clinic with bleeding from the gums and nose, difficulty breathing, generalized pain, stiff gait, and mild hypothermia. The dog had an abdominal fluid wave in the abdomen, but minimal fluid or blood was obtained via abdominocentesis. Abnormalities noted on blood work included an elevated liver enzyme (ALT), elevated blood urea nitrogen, mild hyperphosphatemia, mild hyperglycemia, and prolonged activated clotting time. A full complete blood count was pending, but preliminary results showed increased reticulocytes and thrombocytopenia. The veterinarian confirmed the dogs Rabies vaccine was current, but had not been vaccinated for distemper of Lyme disease. Recommendations included further coagulation parameter testing, treatment with vitamin K1, whole blood or plasma transfusion, and supportive care as needed. A second dog in the home (Patient 2) was presented to the clinic on November 1, 2017 with weakness, soreness, and vocalization. The dog was treated with vitamin K1, sucralfate, fluids and discharged after the pet owners declined hospitalization, diagnostics, and further treatment. The dog later died at home at approximately midnight on November 2, 2017. Ingestion of an unknown amount of Jaguar blocks may have occurred several days prior but no ingestion was witnessed for either dog. The pet owners are farmers and are not sure where the blocks were placed around the property. The caller did not have the product EPA Registration Number but was told by the pet owner that he buys the Jaguar blocks that come in a bucket (20-gram blocks, active ingredient brodifacoum).No further information was received regarding the status of Patient 1.


To be determined by Registrant

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

Major

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Border Collie

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.75

7. Weight (provide a range if necessary )

33.00

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

  • General
    • Symptom - Death
    • Symptom - Pain
    • Symptom - Vocalizing
  • Nervous and Muscular Systems
    • Symptom - Muscle weakness

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 Speculate exposure to pesticide

17. Provide any additional details about the incident

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

11/7/2017 10:42:14 AM A veterinarian reported they were currently treating a dog (Patient 1) which was presented to the clinic with bleeding from the gums and nose, difficulty breathing, generalized pain, stiff gait, and mild hypothermia. The dog had an abdominal fluid wave in the abdomen, but minimal fluid or blood was obtained via abdominocentesis. Abnormalities noted on blood work included elevated alanine transaminase, elevated blood urea nitrogen, mild hyperphosphatemia, mild hyperglycemia, and prolonged activated clotting time. A full complete blood count was pending, but preliminary results showed increased reticulocytes and thrombocytopenia. The veterinarian confirmed the dogżżżżżżs Rabies vaccine was current, but had not been vaccinated for distemper of Lyme disease. Recommendations included further coagulation parameter testing, treatment with vitamin K1, whole blood or plasma transfusion, and supportive care as needed. A second dog in the home (Patient 2) was presented to the clinic on November 1, 2017 with weakness, pain, and vocalization. The dog was treated with vitamin K1, sucralfate, fluids and discharged after the pet owners declined hospitalization, diagnostics, and further treatment. The dog later died at home at approximately midnight on November 2, 2017. Ingestion of an unknown amount of Jaguar blocks may have occurred several days prior but no ingestion was witnessed for either dog. The pet owners are farmers and are not sure where the blocks were placed around the property. The caller did not have the product EPA Registration Number but was told by the pet owner that he buys the Jaguar blocks that come in a bucket (20-gram blocks, active ingredient brodifacoum).No further information was received regarding the status of Patient 1.


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.