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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-3135

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: MANITOBA

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:

  • 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: alfalfa crop

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

The pesticide was applied with a commercial sprayer (attached to vehicle, no implement) to alfalfa. The conditions at the time of planting were sun and cloud, wind NW (away from hive), temp in high teens. Was spraying at noon in wind, and the crop was planted 200 feet 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

Abnormal behavioural effects


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

Bee mortality was observed on 2012-06-12 and was visited on 2012-06-27; a bee sample was not collected. There were 20 hives in the bee yard, with 20 hives showing mortality. The estimated number of dead bees was 50 percent of each colony. 10-15 colonies really hard hit. Foraging bees are dead because are not out flying, even in ideal conditions for foraging; hives set back by at least 3 weeks. Queen has slowed. Unsure of effects on brood because not yet out of cells The state of the colony afterwards was unknown.Hive has been at yard for a few yrs. -One of best yards, was split and requeened May 17. -Treated fall 2011 w formic acid, mite white pads, trt spring 2012 Acivar, Fumigelan B, Carimicin (sp?). Had nozema, varro mites in 2011, and as well flooding affecting colonies (90% 2011) but in 2012 only 10% affected before this incident. heavy rains occurred 2 wks after incident

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