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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3621

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).

In 2012, the following treatments were applied to the hives: formic acid and antibiotics. In 2013, the following treatments were applied to the hives: antibiotics and formic acid. Information on crops located near the beeyards: apple orchard was 1 m from the beeyard;200 ac of corn was 300 m from the beeyard, and was planted between 2013-05-04 to 2013-05-09.It was suspected that a seed treatment was used on the crop;Woodlot was 500 m from the beeyard; 2 ac of woodlot was 5 m 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)

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


Reproductive impairment

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

There were a total of 31 colonies in the bee yard. There were 28 affected colonies.The average number of dead adult bees per colony was 0 - 500 per colony and found dead outside of hive, bottom board, dragging out. Bees were actively foraging at the time of the incident. Adult bee symptoms included shaking,/trembling/ crawling, disorientation and twitching. Additionally rolling on back, tongues out, stronger hives more impacted, lethargic. Brood symptoms included spotty brood pattern. Additionally, possible spotty brood production. No queen symptoms observed. Sample of composite dead bees taken from affected hive and affected yard hives U,V,W,X, Y, Z, and 1. Positive detects found for clothianidin, pyrimethanil and thiabendazole. Samples of live bees from unaffected hive and sample from unaffected live bees from hive B, had no detected active ingredients. Sample of pollen taken from affected hive and affected pollen comb (hive Z). The following actives had positive detects: carbendazim, chlorimuron-ethyl, clothianidin, diuron, imazamethabenz-methyl, imidacloprid, propamocarb, pyrimethanil, thiabendazole, thiamethoxam, thiopanate-methyl. Sample of pollen taken from affected hive and affected pollen comb (hive 4). The following actives had positive detects: carbaryl, carbendazim, clothianidin, diuron, propamocarb, pyrimethanil, thiabendazole, thiamethoxam, thiopanate-methyl. Sample of honey taken from affected hive and affected pollen comb (hive 4). The following actives had positive detects for carbendazim, clothianidin, propamocarb, thiamethoxam and thiopanate-methyl. The weather at the time of the incident was cool. Prior to the incident, the health of the yard was doing well. The following pests were present in the affected bee yard in the past year: European foulbrood (EFB), sacbrood, varro a mite and lots of chalkbrood. After the incident, the average frames of brood was the same as before. It was too soon to tell if the previously noted disease or pest got worse after the incident. Additional food sources provided to the bees included sugar syrup (fall granular + water) and pollen supplement. I

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