Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-2091

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

15-APR-12

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. 27045      PMRA Submission No.       EPA Registration No.

Product Name: CRUISER 5FS SEED TREATMENT

• Active Ingredient(s)
  • THIAMETHOXAM

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: Corn seed

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Pesticide is on corn seed. Air Planters seem to be worse. I won't know until samples are analyzed 'suspected'. Thiamathoxam PCP Reg#27045. The only other thing I would like to add, if this is a minute amount of Dust off of corn seed treatment. Blowing through the air and killing bees, what is it doing to other bugs & animals & even humans. Maybe we can do without insecticides this powerfull. Name, address, phone number.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

Honey bee

3. Scientific name(s)

Apis Malifera

4. Number of organisms affected

56000

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

Death

7. Describe symptoms and outcome (died, recovered, etc.).

Death of individual Bees, not full Hives. Early symptoms twitching. Bees seemed to lose control of body movements. Per Hive about 100 Bees. Total approximately 56000 bees. Dead bees. Colonies have recovered, but corn planting is not complete.

8. a) Was the incident a result of (select all that apply)

Application

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Yes

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

13. Please provide supplemental information here