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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3634

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: antibiotics. Information on crops located near the beeyards: Corn was located 10m from the beeyard. Other crops in the area include wildflower, wild apple, cherry, ponds. Soy was located 10m from the beeyard. Other crops in the area include wildflower,wild apple, cherry, ponds. Update from Beekeeper on July 22 indicated he has started losing queens, beginning 2 wks after inspection. Was missing 2 queens, no new brood. He couldn't get new queens, but got queen cells from another beekeeper. He checked 2 weeks later and 1 took but another hive was queenless with no brood. He was then able to get 2 queens and installed. Only 1 took, leaving 1 queenless,so he combined with another queened hive. He says he has never experienced such a situation like this before. Initial call (May 17): Split hives May 8 and introduced new queens, observed unusual amount of dead bees in and around hives. Approximately 150-200 bees in front of one hive, both strong hives. 5 hives all together. Lots of planting in area, both corn.

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 4 colonies in the bee yard. There were 4 affected colonies. There were 501 - 1000 dead bees per colony. Dead bees were observed outside the hive. Bees were actively foraging at the time of the incident and dead bees had pollen on their legs. Adult bee symptoms included being aggressive, shaking/trembling/twitching. crawling. Brood symptoms included chalk brood, low mite numbers. There was evidence of queen missing from aggressive hive. Sample of pollen taken from affected hive, comb sample, had positive detects for clothianidin. Sample of pollen taken from affected hive, comb sample, had positive detects for thiamethoxam. Sample of water taken from pond water had positive detects for thiamethoxam. Samples of live bees taken from unaffected hive had no detected active ingredients. Sample of dead bees taken from affected hive, had positive detects for clothianidin. The weather at the time of the incident was sunny, calm at dusk, 24C. Prior to the incident, there were an average of 9 frames of bees, 8 - 9 frames of brood, and 8 - 9 frames of pollen and honey. The following pests were present in the affected bee yard in the past year: Chalkbrood and varroa mite. The previously noted disease(s) or pest(s) did not get worse after the incident. After the incident, there were an average of 4 - 5 frames of bees, 4 - 5 frames of brood, and 9 frames of pollen and honey. Additional food sources provided to the bees included one pad pollen supplement April; attempted to feed sugar syrup did not feed on sugar feeder.

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