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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3626

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. In 2013, the following treatments were applied to the hives: formic acid.Information on crops located near the beeyards: corn (cedar hedgerow and blueberries btwn corn and hives)was 200 m from the beeyard, and was planted on April 30 2013; 3 - 5 ac of blueberries surrounding yard was 1 m from the beeyard. Roundup on pathways was used on the crop.;tomatoes were 500 m from the beeyard. 3/4 hives did not get through winter, possibly because of varroa mite? Honey was left in each and was transferred to 3 new colonies bought from another beekeeper. It was these new hives (and the one remaining live hive) that showed an effect. One hive (Hive #4) purchased after corn planting, and this was the strongest hive. The beekeeper indicated that in 2011/2012 the bees overwintered strong. In 2012, he thinks he may have hand an incident (but didn't report). It was a rough year, a bad honey year, the worst year since keeping bees. Initial call (May 14): 3 hives from BK 3 weeks ago. Well but last week notice dead bees (approx. 1/2 cup maybe). Field next door don't know if planted recently. Hives in blueberry patch. Only 4 hives yard. Corn last year very dusty.

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 4 colonies in the bee yard. There were 4 affected colonies and 3 dead colonies overwinter deaths, replaced with new hives prior to incident. There were 0 - 500 dead bees per colony observed outside the hive. Bees were actively foraging at the time of the incident. Pollen being brought in. Adult bee symptoms included shaking, trembling, twitching, crawling, disoriented. Additionally bees were docile, not finding entrance.Too soon to see queen symptoms. One queen: only drone brood v. small wings from nuc last spring). Sample of dead adult bees taken from affected hive had positive detects for clothianidin and thiamethoxam. Sample taken from affective hive had positive detects for thiamethoxam. Samples of affected live bees, affected hive, taken had no detected active ingredients. Samples of water taken from big pond had no detected active ingredients.Samples of water had no detected active ingredients. The weather at the time of the incident was sunny dry windy warm. Prior to the incident, there were an average of 4 frames of bees (3 were replacement hives that had just been purchased from another beekeeper frames of bees.The following pests were present in the affected bee yard in the past year; varro a mite. After the incident, there was 1 hive weaker than it should be, other added brood chamber to it. 2 hives had no more brood. Additional food sources provided to the bees included sugar syrup spring.

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