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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-6336

2. Registrant Information.

Registrant Reference Number: 2483436

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.

18-JUL-19

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

10-JUL-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. 12455-80-3240

Product Name: Tomcat All-Weather Bait Chunx, 4 lb. pail

  • Active Ingredient(s)
    • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM SALT)
      • 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

Mixed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

112.00

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
    • Specify - blood in chest
    • Symptom - Leukocytosis
    • Symptom - Thrombocytopenia
  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Grass ingestion
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Fever
    • Symptom - Lethargy
  • Renal System
    • Symptom - Urine discoloration
    • Symptom - Blood in urine
  • Respiratory System
    • Symptom - Coughing
    • Symptom - Pneumonia
    • Symptom - Other
    • Specify - Respiratory arrest
    • Symptom - Laboured breathing

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?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown exposure

17. Provide any additional details about the incident

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

7/18/2019 A pet owner reported her son's therapy dog recently died. There was no known or witnessed exposure, but the owner was concerned that the dog may have been exposed either directly or indirectly to the product. Another dog in the home remained asymptomatic. On July 10, 2019 the dog developed symptoms of ingestion of grass and emesis. On July 11, 2019 the dog was evaluated by a veterinarian. Baseline laboratory testing was performed including a complete blood count (CBC), chemistry profile, and urinalysis. The CBC revealed a high white blood cell count (leukocytosis) and the urinalysis showed the presence of both red and white blood cells in the urine. The dog was started on a course of antibiotics. Emergency veterinary evaluation was sought that evening due to worsening signs. On July 12, 2019 an ultrasound and radiographs were performed with possible pneumonia diagnosed. Blood work showed a low platelet count (thrombocytopenia) so the dog was treated with vitamin K1. At an unspecified time, the dog developed anorexia, lethargy, green discolored urine, labored breathing, coughing, and blood in its chest. The dog was placed in an oxygen chamber but went into respiratory arrest. Resuscitation was attempted but unsuccessful. The pet owner was unsure of the exact date of the dog's death. No necropsy was performed but the owner reportedly consulted with the Washington State University toxicology department which thought the dog's signs were indicative of an infection. 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.