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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3650

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

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 12 colonies in the bee yard. There were 12 affected colonies. There were 0 - 500 dead bees per colony observed outside of hive. Bees were actively foraging at the time of the incident. Dead bees had pollen on their legs. After the adverse effects there was a noticeable decline in foraging. Adult bee symptoms included shaking/trembling/twitching, disoriented. Additionally, loss of field bees (foragers). Brood symptoms included spotty brood pattern and overall decline in brood production. Queen symptoms included unusual laying pattern. Additionally, queen is laying less eggs because a lack of bees. Nursing bees going out to forage (to replace field loss) and less nursing bees on hive.Sample of water taken from water sample adjacent to corn field, sample of water that puddled in field had positive detects for clothianidin. Samples of water, water sample adjacent to corn field, sample of water that puddled in field, had no detected active ingredients. Sample of pollen taken from affected hive, comb from yard had positive detects for clothianidin and thiamethoxam. Samples of live bees taken from affected hive, had no detected active ingredients. Sample of dead bees taken from affected hive, composite of dead bees had positive detects for clothianidin. The weather at the time of the incident was dry weather, soil not dry, nice warm temp. Prior to the incident, there were an average of 4 to 5 frames of bees, 4 to 5 frames of brood, and >4frames of pollen and honey. After the incident, there were an average of 3.5 frames of bees, 3.5 frames of brood, and >4 frames of pollen and honey. Sugar syrup in the fall. In 2012, the following treatments were applied to the hives: formic acid, fluvalinate-tau, antibiotics. In 2013, the following treatments were applied to the hives: antibiotics. Information on crops located near the beeyards: 100 ac of corn was adjacent from the beeyard, and was planted between May 3 and May 8. BK noted only 1 yard as reporting effects, she was unable to confirm the size of the yard or number of hives affected. Hives were checked Friday, May 10 and they were strong. Planting of corn happened in the area and when hives checked on May 9th, weak bees with pesticide exposure symtoms were observed. Questionnarie was then completed for another yard. This yard overall was weak, a heavy winter loss was experienced a this location. However, beekeeper also ntoed that many additional yards were potentially affected.

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