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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-0495

2. Registrant Information.

Registrant Reference Number: 2177630

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.

25-JAN-18

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

25-JAN-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. 26859      PMRA Submission No.       EPA Registration No.

Product Name: Jaguar 50 Rodenticide Place Pac Kills Rats & Mice (Canadian)

  • Active Ingredient(s)
    • BRODIFACOUM

7. b) Type of formulation.

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

Dog / Chien

3. Breed

Beagle

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

20.00

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 - Bloody vomit

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

1/25/2018 4:24:44 PM A pet owner reported that 90 minutes prior his dog ingested up to 1/3 of a pack of product. He contacted a veterinarian who recommended giving the dog 1 tablespoon of salt orally to induce vomiting. The owner followed these instructions and the dog did vomit 3-4 time with blood noted in the vomitus. The owner also noted that some of the product may have been ingested by the dog on a different day. It was recommended the dog be evaluated that day and started on vitamin K1 therapy. Approximately 30 minutes later the pet owner called back to report he weighed the package of product he dog chewed on and compared it to a new pack, and both weighed 27 grams. Because of this, the owner now suspected the dog may have ingested none of the product or only a few pellets. The owner also clarified that if prior exposure occurred it would have been from ingestion of an exposed rodents and not ingestion of the bait product itself. The owner also felt the blood noted in the dog's vomitus was due to administration of salt and not the product. No further vomiting had occurred, and the dog was otherwise acting normally. The owner was having difficulty seeking veterinary evaluation that night. Signs to monitor for were discussed along with the option of starting the dog on vitamin K1 as a precaution the following day. 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.