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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-3125

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: x

  • 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).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: treated soybean

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

Soybeans planted with Sunflower Drill, Model 9413. The pesticide was applied: seed treatment. The conditions at the time of planting were hot and dry, and the crop was planted unknown distance from the beeyard.

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


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

Bee mortality was observed on 2012-04-19, 2012-04-26, 2012-05-15 and was visited on 2012-04-21, 2012-05-02, 2012-05-18; a bee sample was collected on 2012-04-21, 2012-04-20, 2012-05-02, 2012-05-18, 2012-05-14. There were 14 hives in the bee yard, with 10 hives showing mortality. The estimated number of dead bees was between number of 600 to 1200 at each colony (6000-12000 in total). The observed symptoms were: unknown. The state of the colony afterwards was: unknown.DEAD BEES. 2 separate samples collected at home yard. bee pollen also sampled. Additional kill inspected 2 May, now looks like 7 out of 9 bee yard effected. Additional visit by PMRA May 4 with a low level kill still occuring, and a bee pollen sample was obtained from the beekeeper. Additional visit by PMRA May 18th for new bee kill incident, new sample obtained. May 28 HC RAPB visit: bee kills have stabilized. DEAD BEES. 2nd inspection at home yard, cannot attribute to a particular planting event. Bee pollen collected btwn May 2 and May 4. May 28 HC RAPB visit: bee kills have stabilized. DEAD BEES. 3rd inspection at home farm. No results in May 25th lab results for this sampling. nukes moved to home yard from another yard on May 12/13. Were closed until May 15 with piece of screen. Bee keeper opened nukes on May 15 and noticed kill in hives. Kill must have occurred in the hive as bees were not able to fly. Hive fanning occurred May 14 as temp was hot. May 28 HC RAPB visit: bee kills have stabilized.

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