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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3646

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 21 colonies in the bee yard. There were 7 affected colonies. There were 5000 dead bees per colony observed outside the hive. Bees were actively foraging at the time of the incident. Dead bees had pollen on their legs. Some had yellow pollen on cap. Adult bee symptoms included crawling. Additionally, the bees were dead, some bees were crawling in front of 2 affected hives. Brood symptoms included spotty brood pattern. Additionally, affected hive had no eggs or young larvae.Queen symptoms included dead queen, queen stopped laying and unusual laying pattern. Additionally, spotty brood pattern due to unusual laying pattern.Sample of dead bees taken from affected hive, dead bees had no detected active ingredients. Sample of dead bees taken from affected hive, dead bees had no detected active ingredients. Sample of dead bees taken from affected hive, dead bees had positive detects for clothianidin. Samples of dead bees taken from affected hive, dead bees had no detected active ingredients. The weather at the time of the incident was Sunny, dry, temp was hot 30C, humidity muggy. Prior to the incident, there were an average of 7 frames of bees, 7 frames of brood, and 1 - 2frames of pollen and honey. The following pests were present in the affected bee yard in the past year; Varroa a mite. After the incident, there were an average of 3 to 4 frames of bees, 3 frames of brood, and 2 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, fluvalinate-tau and antibiotics. Information on crops located near the beeyards: Forage crops, wild mustard crops and posture crops are located near the affected bee yard.Bkeeper reported that one of his yards experienced a significant kill two days ago (approx. 5000 bees). He also reported another Yard is weak. BK estimates that he lost around 600 hives over the last two season (38 million bees).

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