Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-6056

2. Registrant Information.

Registrant Reference Number: 2282298

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-AUG-18

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

01-AUG-18

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. 12455-120-3240

Product Name: Tomcat Mouse Killer I (refillable 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

Australian Shepherd (Aussie)

4. Number of animals affected

2

5. Sex

Male

6. Age (provide a range if necessary )

0.12

7. Weight (provide a range if necessary )

3.00

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 - Death

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

8/2/2018 11:00:48 AM A pet owner reported that 21 hours prior her litter of six puppies ingested an unknown amount of product from a 16 oz bag of Tomcat Mouse Killer I. The owner did not know how full the bag was when the puppies got into it but noted the bag was empty after the puppies had access. Shortly after ingestion caller induced emesis with 1oz of H2O2 for each puppy. The owner noted that three of the puppies vomited with bait present in the vomitus. The three other puppies did not vomit. All six puppies were asymptomatic when the owner went to bed that night. The morning of August 2, 2018 the owner found two of the puppies deceased. One puppy had vomited and was having difficulty breathing. The three other puppies remained asymptomatic. No veterinary care was sought prior to the call but was recommended for the surviving puppies. No further information was received in this case.


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

Australian Shepherd (Aussie)

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.12

7. Weight (provide a range if necessary )

3.00

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 - Vomiting
  • Respiratory System
    • Symptom - Difficulty Breathing

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

8/2/2018 11:00:48 AM A pet owner reported that 21 hours prior her litter of six puppies ingested an unknown amount of product from a 16 oz bag of Tomcat Mouse Killer I. The owner did not know how full the bag was when the puppies got into it but noted the bag was empty after the puppies had access. Shortly after ingestion caller induced emesis with 1oz of H2O2 for each puppy. The owner noted that three of the puppies vomited with bait present in the vomitus. The three other puppies did not vomit. All six puppies were asymptomatic when the owner went to bed that night. The morning of August 2, 2018 the owner found two of the puppies deceased. One puppy had vomited and was having difficulty breathing. The three other puppies remained asymptomatic. No veterinary care was sought prior to the call but was recommended for the surviving puppies. No further information was received in this case.


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.