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Incident Report
Subform I: General Information
1. Report Type.
Update the report
Incident Report Number: 2012-3123
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.
01-MAY-12Product 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.
Product Name: x
- Active Ingredient(s)
- CLOTHIANIDIN
- THIAMETHOXAM
7. b) Type of formulation.
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).
Corn planted. The conditions at the time of planting were unknown, and the crop was planted 'adjacent' from the beeyard.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)
3. Scientific name(s)
4. Number of organisms affected
12000
5. Description of site where incident was observed
Fresh water
Terrestrial
Agricultural
Salt Water
6. Check all symptoms that apply
Death
7. Describe symptoms and outcome (died, recovered, etc.).
Bee mortality was observed on 2012-05-01 and was visited on unknown date. There were unknown number of hives in the bee yard, with 30 hives showing mortality. The estimated number of dead bees per colongy affected was between 300 to 500 bees (9000-15000 in total). The observed symptoms were dead bees in front and outside of the colony, dead bees were cleared out later. The state of the colony afterwards was unknown.Dead bees in front and outside of the colony, dead bees were cleared out later, adjacent 200 acres were being seeded with corn,
8. a) Was the incident a result of (select all that apply)
Unknown
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?
No
