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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3659

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 6 colonies in the bee yard. There were 2 affected colonies and 2 dead colonies. There were 501 - 1000 dead bees per colony observed outside of hive. Bees were actively foraging at the time of the incident. Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. Proboscis out onmat bees. It was too early to tell on the brood symptoms. No queen symptoms observed.Samples of vegetation taken from vegetation from the East side of the field had no detected active ingredients. Sample of pollen taken from strong hive, unaffected control comb sample from yard had positive detects for clothianidin and thiamethoxam. Samples of pollen taken from affected hive, affected comb sample from yard had no detected active ingredients. Samples of honey taken from affected hive, affected comb sample from yard. There was insufficient quantity for the sample to be analyzed had no detected active ingredients. Samples of live bees taken from strong hive, unaffected live bees, control, from yard had no detected active ingredients.Sample of dead bees taken from affected hive, affected dead bees from yard had positive detects for clothianidin. The weather at the time of the incident was Overcast/cloudy, light breeze, 20 C, high humidity. The following pests were present in the affected bee yard in the past year; chalkbrood and varroa mite. Additional food sources provided to the bees included Sugar syrup, pollen supplement. In 2012, the following treatments were applied to the hives: formic acid. In 2013, the following treatments were applied to the hives: amitraz and antibiotics. Information on crops located near the beeyards: 15ac of corn was 2m from the beeyard, and was planted on 2013-05-27. Other crops in the area include forage crops, winter wheat, corn (1TL - 2TL); 60ac of beans was 100m from the beeyard; 100ac of pasture was 150m from the beeyard;The crop loacted near the affected bee yard was forest. BK has 22 yards, reporting 1 affected yard within 24 hours of corn planting on neighbouring field. He noticed a die off on May 28, 2013 and more dead bees the following morning. Two of the 6 hives at the yard were affected. The main colony affected had just been brought into the yard for raising queens and was heavily affected - half a cup dead. Wind was from north when corn planting occurred. Blowing towards hives. Bee, pollen and honey samples were collected for anaysis.

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