Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2021-1940

2. Registrant Information.

Registrant Reference Number: 2849448

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.

09-JAN-21

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

26-DEC-20

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 12455-132-3240

Product Name: Tomcat with Bromethalin Bait Chunx

• Active Ingredient(s)
  • BROMETHALIN
    • Guarantee/concentration .01 %

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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

Chihuahua

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.83

7. Weight (provide a range if necessary )

3.00

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

• Gastrointestinal System
  • Symptom - Rectal hemorrhage
  • Symptom - Vomiting

• General
  • Symptom - Death

• Gastrointestinal System
  • Symptom - Other
  • Specify - Released material from anal glands

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?

Other / Autre

specify Speculated exposure to rodenticide

17. Provide any additional details about the incident

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

On 09-Jan-2021 a pet owner reported the deaths of two dogs and persistent signs in their two other dogs. No ingestion was witnessed for any of the dogs, but the owner was concerned as the product was present in the home. On 26-Dec-2020 one of the dogs developed vomiting, though the owner could not specify which. On 01-Jan-2021 one dog developed bleeding from the rectum, released material from its anal glands, and died an unspecified amount of time later that day. No veterinary care occurred, and the owner was considering pursuing a necropsy. The three other dogs developed persistent anorexia and vomiting. On 04-Jan-2021 the three dogs were evaluated by a veterinarian and prescribed vitamin K1 and anti-nausea medication. On 09-Jan-2021 one dog developed ataxia and died at home two hours later. The two surviving dogs were brought back to the veterinarian and treated with IV fluids at the time of the report (coded as moderate severity). No further information was received.

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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

Chihuahua

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

3.00

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

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Ataxia

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 exposure to rodeniticide

17. Provide any additional details about the incident

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

On 09-Jan-2021 a pet owner reported the deaths of two dogs and persistent signs in their two other dogs. No ingestion was witnessed for any of the dogs, but the owner was concerned as the product was present in the home. On 26-Dec-2020 one of the dogs developed vomiting, though the owner could not specify which. On 01-Jan-2021 one dog developed bleeding from the rectum, released material from its anal glands, and died an unspecified amount of time later that day. No veterinary care occurred, and the owner was considering pursuing a necropsy. The three other dogs developed persistent anorexia and vomiting. On 04-Jan-2021 the three dogs were evaluated by a veterinarian and prescribed vitamin K1 and anti-nausea medication. On 09-Jan-2021 one dog developed ataxia and died at home two hours later. The two surviving dogs were brought back to the veterinarian and treated with IV fluids at the time of the report (coded as moderate severity). No further information was received.

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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

Unknown

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

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 rodenticide

17. Provide any additional details about the incident

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

On 09-Jan-2021 a pet owner reported the deaths of two dogs and persistent signs in their two other dogs. No ingestion was witnessed for any of the dogs, but the owner was concerned as the product was present in the home. On 26-Dec-2020 one of the dogs developed vomiting, though the owner could not specify which. On 01-Jan-2021 one dog developed bleeding from the rectum, released material from its anal glands, and died an unspecified amount of time later that day. No veterinary care occurred, and the owner was considering pursuing a necropsy. The three other dogs developed persistent anorexia and vomiting. On 04-Jan-2021 the three dogs were evaluated by a veterinarian and prescribed vitamin K1 and anti-nausea medication. On 09-Jan-2021 one dog developed ataxia and died at home two hours later. The two surviving dogs were brought back to the veterinarian and treated with IV fluids at the time of the report (coded as moderate severity). No further information was received.

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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.