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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-4525

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. 30324      PMRA Submission No.       EPA Registration No.


  • Active Ingredient(s)
      • Guarantee/concentration 46.7 %

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


Other Units: strips per honey bee colony

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

Site: Other / Autre

Préciser le type: hive treatment

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

Application rate: 2 strips per honeybee colony. Site examples: single brood chamber (19), double brood chamber (34). Method of Application: As directed on label, 27 degrees. Reason to treat:varroa mite control.

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.).

14 out of 19 queens in single brood chamber (74%), 20 out of 34 queens in double brood chamber (59%). Death of queens. Emergency cells (queen cells) drawn in some queenless behaviour in some colonies. New queens were introduced to queenless colonies.Honey bee colonies will not survive without a queen. Of the 53 colonies treated, 64% (34) queens were killed. This is an unacceptable rate at any time of the year. Colonies trying to replace a queen killed by Formic Acid in September would not be successful because: 1 - Inferior quality of cells 2 - Sub-optimal mating weather 3 - Lack of sexually mature drones (male honeybees). Economic impact of queen loss: 27 queens at $30 each total $810; 8 nucleus colonies at $180 each total $1440. Total queen replacement cost $2250.Does not include labour, time lost, psychological stress. The label information precautions/application instructions did not prepare us for such a high percentage of queen mortality.

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