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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3641

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


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

There were a total of 29 colonies in the bee yard. There were 29 affected colonies. The location of dead adult bees was outside of hive. Sample of dead bees taken from affected hive had positive detects for pyraclostrobin. Samples of honey taken from affected hive, pollen comb had no detected active ingredients. Sample of pollen taken from affected hive, pollen comb had positive detects for pyraclostrobin. Samples of live bees taken from unaffected hive, strong hive had no detected active ingredients.The weather at the time of the incident was unknown. Other crops in the area include pollen was noted in frames: yellow, orange and white. Inspt noted that white pollen is likely from corn. Two yards were inspected, however, bee keeper also reported effects in 3 other additional yards . In yard 1 29 hives in total. OMAF Inspec collected a dead bee sample. He commented not a lot of pollen in frames. 3 pollen sources: yellow, orange and white. White pollen was likely from corn. Queens were still laying. All stages of brood were present. Queens were good. There were some crawling bees and bees were dragging dead bees outside the hives. Birds and yellow jackets were scavenging the dead bees. Bees were out fielding, but there was not a huge field force in the air. Every hive was some what affected. No mite in sample

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