Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3658

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


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

There were a total of 26 colonies in the bee yard. There were 5 affected colonies. There were > 2000 dead bees per colony observed outside the hive. Bees were actively foraging at the time of the incident. Foraging that day. Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented and no adult symptoms. Brood symptoms included spotty brood pattern. Queen symptoms included failure of the colony to re-queen itself. There were some issues in the past.Sample of water taken from water from flowing culvert west of bee yard had positive detects for clothianidin. Samples of pollen comb taken from unaffected hive, strong hive, affected yard had no detected active ingredients. Samples of pollen taken from affected hive had no detected active ingredients. Samples of pollen taken from affected hive had no detected active ingredients. Samples of brood honey taken from affected hivehad no detected active ingredients.Sample of dead bees taken from affected hive had positive detects for pyraclostrobin. The weather at the time of the incident was sunny and warm. Prior to the incident, the frames of bees were doing ok and frames of pollen and honey had honey on it. It was too soon to tell if previously noted disease(s) or pest(s) got worse after the incident. Additional food sources provided to the bees included Sugar syrup, pollen supplement. In 2013, the following treatments were applied to the hives: amitraz and antibiotics. Information on crops located near the beeyards: 100ac of corn was 20m from the beeyard. Other crops in the area include located on cash crop farm. 2 sides of yard back on to bush. Corn to NW. Culvert drains field water into creek W of beeyard. Fields injected w/ sewage 2 years ago. Lots of star thistle (not prickly) in ditches, bees actively foraging on it during inspection.

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