Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-3238

2. Registrant Information.

Registrant Reference Number: 3821660

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.

11-JAN-24

5. Location of incident.

Country: UNITED STATES

Prov / State: WASHINGTON

6. Date incident was first observed.

07-JAN-24

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. 12455-146

Product Name: Contrac Soft Bait

• Active Ingredient(s)
  • BROMADIOLONE
    • Unknown

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

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

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

65.00

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

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Vomiting

• Respiratory System
  • Symptom - Nose bleed

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unconfirmed but suspected ingestion.

17. Provide any additional details about the incident

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

1/11/2024 On the morning of 07 Jan 2023, the dog was normal. After breakfast, the dog vomited once then was lethargic all day. The owner offered white rice and chicken and the dog refused. That evening the dog went to bed. When the owner woke up at midnight, she discovered a puddle of blood that was equal to about 2 cups. Then she discovered the deceased dog laying with its head over the bed. The dog was dripping blood from the mouth and nose. The dog was then taken to veterinarian for cremation where it was suggested to search for toxins as dog was healthy. The owner then found crumbles of the Contrac Soft Bait and a chewed-up bait station that was put out by a pest control operator. It is unknown how much bait was put out or how much might have been ingested. Necropsy was performed where no blood in the abdomen was visualized. The dogas liver was sent to Michigan State for review. Results pending, can take weeks for results. 1/12/2024 Animal owner callback to report blocks were crumbled and in the soil when she found them, and caller has had two pest control operators come out to remove remains of product. However, caller is worried soil is still contaminated as she continues to find bits of product in soil. Caller is wondering safety of this and how to clean up the area so her other three dogs, who all remain asymptomatic and are not included in this report as such, can re-enter the area. Caller reports per pest control operator, three to four 1-ounce blocks were placed and caller reports 60% had been missing when she found the destroyed station. Caller is also concerned with potential for chronic ingestion. Station was last filled in September 2023 or November 2023. No further information is available.

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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.