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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3661

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 15 colonies in the bee yard. There were 15 affected colonies and 6 dead colonies. There were > 2000 dead bees per colony observed outside of hive. Bees were actively foraging at the time of the incident. After the adverse effects there was a noticeable decline in foraging. Fewer bees in hives after dead bees noticed.Bees too busy cleaning out hive - should be foraging. Adult bee symptoms included aggressive, shaking/trembling/twitching, crawling. K-wing symptoms, bees in hive carrying out dead bees. Proboscis out on affected bees. Brood symptoms included spottty brood pattern. More brood than bees to cover, loss of bees noticable. Spotty and dead brood - chalkbrood would move in because of lack of maintenance and heat on brood. Queen symptoms included emergency/supersedure queen cells, no queen symptoms observed. Making new queen, swarming and leaving, abandon box.Sample of dead bees taken from affected hive had positive detects for clothianidin. Samples of live bees taken from strong hive, unaffected live bee sample control, had no detected active ingredients.Sample of pollen taken from affected hive, comb sample, had positive detects for clothianidin, napropamide and thiamethoxam.Sample of pollen taken from strong hive, unaffected comb sample control,had positive detects for clothianidin.

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