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: 2019-4226

2. Registrant Information.

Registrant Reference Number: 2436630

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-MAY-19

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

06-MAY-19

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. 12455-91

Product Name: Final Rodenticide RTU Place Pac

  • 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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Toy Poodle

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

7.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Loss of appetite
    • Specify - Refused to eat
  • General
    • Symptom - Death
    • Symptom - Vocalizing
    • Specify - Whining when picked up
  • Respiratory System
    • Symptom - Shortness of breath

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 of pesticide

17. Provide any additional details about the incident

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

First call received 5/7/2019 7:57:54 AM. On April 29, 2919, a pet owner found an open pouch of Final Rodenticide RTU Place Pac on her dog's bed. She didn't know if the dog ingested any pellets or not and did not seek veterinary care. On May 6, 2019 the dog developed shortness of breath and was whining if picked up. On May 7, she refused to eat. At the advice of the Bell Labs medical line, she was advised to bring her dog immediately to her veterinarian for examination and possible treatment. Later that same day, her dog was examined by a veterinarian and treated with an injection of Vitamin K1 and also started on oral Vitamin K1 pills and a high fat diet to encourage Vitamin K absorption. No mention of diagnostic tests or physical exam findings were given by the pet owner. She was advised by the veterinarian to bring her dog back the following day for a blood transfusion. On May 9, 2019, the pet owner reported that her dog died at home later in the afternoon of May 7. She reported there is a second dog in her home which was asymptomatic. Veterinary evaluation and diagnostic testing were recommended for the second dog.


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.