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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3616

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: unknown

  • 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: Unknown / Inconnu

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

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)

honey bee


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.).

There were a total of 3 colonies in the bee yard. There were 3 affected colonies and 0 dead colonies. There were 0 - 500 dead bees per hive observed outside of hive. Bees were actively foraging at the time of the incident. Adult bee symptoms included shaking/trembling/twitching and were disoriented. Additionally, the bees were on their backs and kicking, could not fly. Additionally, hives still look strong, did not look at brood.The hives still look strong and did not look at brood.Sample of pollen taken from affected hive,affected comb, hive 2, home yard had positive detects for Clothianidin, Diuron, and thiamethoxam. Sample of pollen taken from affected hive,affected comb, hive 1, home yard had positive detects for clothianidin and thiamethoxam. Sample of dead bees taken from affected hive,dead bees had positive detects for clothianidin. Sample of dead bees taken from affected hive,affected composite dead bee sample from home yardhad positive detects for clothianidin. Samples of live bees taken from strong hive,affected live bees, hive 1, home yard had no detected active ingredients. Sample of live bees taken from strong hive,affected live bees, hive 2, home yard had positive detects for clothianidin. The weather at the time of the incident was 1st event - Sunny and dry, wind from the south 2nd event - dry fairly warm 20C. After the incident, it was too soon to tell the average of frames of bees, frames of brood, and frames of pollen and honey. In 2012, the following treatments were applied to the hives: Formic Acid.In 2013, the following treatments were applied to the hives: Antibiotics. Information on crops located near the beeyards: 10 - 12 ac of corn was 50 m from the beeyard, and was planted on 2013-05-16. Dekalb, Poncho was used on the crop.; 50 ac of corn was 20 m from the beeyard. Pioneer PPS250 was used on the crop. Other crops in the area include corn in front of hives, soybeans next to it and winter wheat too. 1st, 2nd, 3rd 4th and 5th event all occurred btwn May 7 to May 11 (1st corn planting) and 2nd event occurred May 16 (2nd corn planting). Bees were foraging at the time of the case, Symptoms include twitching and disorientation. Brood and queen symptoms were not look at yet. Samples were taken. No disease or pests were noted on the bees. It was too soon to note the health of the affected bee yard after the honey bee case. Treatment for pests and disease was given in both the Fall and Spring. Corn, wheat and soybeans were planted or being planted in the area surrounding the bee yard. Email: 2013-12-11: Colonies didn't recover, more dead bees seen in August. These were 2 strongest colonies from the spring and previous years.

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