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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3664

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 37 colonies in the bee yard. There were 0 - 500 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. Reduction in foraging main symptoms. Adult bee symptoms included shaking/trembling/twitching. Additionally, bees on frame look normal for now, brood looks good for now. Additionally, brood looks good. Additionally, seeing higher than normal queen losses and re-queening (last 4-5 years).Sample of dead bees taken from affected hive, dead bees from yard had positive detects for clothianidin. The weather at the time of the incident was Sunny, dry, calm, temp 24-25C. Prior to the incident, there were an average of approx. 8 frames of bees, approx. 6 frames of brood, and approx. 3 frames of pollen and honey. The were no pests present in the affected bee yard in the past year; After the incident, the average number of frames of bees was the same and slightly less, the average frames of brood was the same, and the average number of frames of pollen and honey was the same. There was no additional food sources provided to the bees. In 2012, the following treatments were applied to the hives: formic acid, amitraz and antibiotics. In 2013, the following treatments were applied to the hives: antibiotics. Information on crops located near the beeyards: 300 ac of corn was 1 km from the beeyard. Information on crops located near the beeyards: Corn was the crop located near the affected bee yard, the distance between the crops from the bee yard was across the road, using a conventional planting method;Corn was the crop located near the affected bee yard, the distance between the crops from the bee yard was across the road - SE of yard, using a negative pressure planter planting method; Corn was the crop located near the affected bee yard, and was planted on 2013-05-09. 80% of foragers affected. Same effect at beekeepers other yard.

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