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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3623

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


Reproductive impairment

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

There were a total of 60 colonies in the bee yard. There were 60 affected colonies. There were 0 - 500 dead bees per colony observed, inside and outside of hive. Fielders are not working today as they should be, bees should be more active. Adult bee symptoms included aggressive. Brood symptoms included Dead larvae/pupae outside of colony, spotty brood pattern. Additionally, colonies started the season with spotty brood and not as strong as they should have been. The queen symptoms included raising queen cells. Samples of water taken, water sample from home yard (water sample from where bees were drinking 150 feet from hives), no detected active ingredients. Sample of dead bees taken from affected hive. Dead bees collected from affected home yard, bee keeper notes as many as 30 bees in one hour. Had positive detects for clothianidin and Thiabendazole.Sample of pollen taken from affected hive, comb sample from home yard had positive detects for clothianidin and thiamethoxam. Sample of dead bees taken from affected hive , dead bees from home yard , had positive detects for clothianidin and thiabendazole. Sample of dead bees taken from affected hive, dead bees from home yard had positive detects for clothianidin. Sample of live bees taken fromhome yard, taken from less affected hive, had positive detects for clothianidin. The weather at the time of the incident was overcast cloudy, light drizzle temp cool. Prior to the incident, there were an average of 4 frames of bees, 4 frames of brood, and lots of frames of pollen and honey. After the incident, there were an average frames of bees was variable - field force is not out and the average frames of brood was variable, and lots frames of pollen and honey. Additional food sources provided to the bees included sugar syrup and pollen supplement.In 2012, the following treatments were applied to the hives: formic acid, amitraz and antibiotics.Information on crops located near the beeyards: 30 ac of corn was 0.25 miles from the beeyard; 50 ac of corn was 0.5 miles from the beeyard. Other crops in the area included corn which was planted across the road, as per maps there were areas where corn was yet to be planted

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