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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3651

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 10 colonies in the bee yard. There were 4 affected colonies. There were 0 - 500 dead bees per colony observed outside of hive. Bees were actively foraging at the time of the incident. Some nectar flow on frames. Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented. Additionally, there was symptoms of trembling, paralyzed, disoriented with limited mobility; not able to fly. Would fall over, wander aimlessly, and shake. No brood symptoms were noticed. Queen symptoms included emergency/supersedure queen cells. Additionally, 1 hive capped.Sample of dead bees taken from affected hive, composite dead bees from hives 1,2, and 3 had positive detects for clothianidin. Sample of pollen taken from affected hive, affected pollen comb, hive 1 yard 5 had positive detects for thiamethoxam. Sample of honey taken from affected hive, affected pollen comb, hive 1 yard 5 had positive detects for fenpyroximate. Samples of live bees taken from affected hive, live bees from unaffected hive #12 in AFFECTED yard (5th sideroad) had no detected active ingredients. The weather at the time of the incident was sunny dry windy. Prior to the incident, the frames of bees were overall weak yard (2/10 strong), 1-2 frames of brood, and 5 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; chalkbrood, nosema and varroa mite. After the incident, it was too early to tell the average frames of bees. Honey (own) and pollen supplement. In 2012, the following treatments were applied to the hives: oxalic acid and antibiotics. In 2013, the following treatments were applied to the hives: antibiotics. Information on crops located near the beeyards: 100 ac of corn was 10m from the beeyard, and was planted on 2013-05-08. Dandelions out, some nectar flow on frames. Stream close by (500 yards)┐water source for bees. Field planted on May 8th, cultivated May 7th. During case stronger bees out foraging, lots of pollen, nectar flow coming in. Dry planting season, overly windy, warm during corn planting. Initial call (May 9): Oxy10 on bees on Monday. Today bees crawling on bottom boards. Adjacent field planted Tues/Wed with corn. 1 yard has 9 affected total, 6 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