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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-3008

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.


4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: a

  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.

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).

warm spell in March. Mite treatment in fall 2011 included Apistan. Earliest corn planting in area would have been April 10. Treated w Apistan fall 2011. As of June 21 2012 the hive is pretty strong, one colony lost a queen. : 2012 is 3rd year for 1 hive (was strongest hive) and the other hives are 1 year old. April 10th would have been very earliest that anyone would have seeded corn. If a farmer had 3000 plus acres to seed he might of had an incentive to start seeding early. However, the vast majority of local farmers would not plant corn seed until after April 19th so that their seed is insured. Barley and wheat are the only other crops that may have been planted easnd of March early April because they are more frost tolerant.

To be determined by Registrant

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


Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

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

2. Common name(s)

3. Scientific name(s)

4. Number of organisms affected


5. Description of site where incident was observed

Fresh water



Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects


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

Bee mortality was observed on 2012-04-18 and was visited on 2012-05-10; a bee sample was collected on May 10. There were 4 hives in the bee yard, with 2 hives showing mortality. The estimated number of dead bees was 10000 per hive. The observed symptoms were Like a pyramid in front of the opening. Still lots feed. Wings folded back.beekeeper noticed one hive was queenless on May 6. Bees seemed healthy before observed incident. The state of the colony afterwards was As of June 21, 2012 the hive is now pretty strong, one colony lost a queen.

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


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

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

9. Did it rain

9. a) During application?


9. b) Up to 3 days after application?


10. a) Was there a buffer zone?


10. b) What type?


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

11. a) Were environmental samples collected and analysed?


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