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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3665

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 1 colonies in the bee yard. There were 1 affected colonies. There were 0-500 dead bees per colony observed outside the hive. After the adverse effects there was a noticeable decline in foraging. Last week lots of foraging, field bees are not coming back, noticeable reduction in forgaging.Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. Additionally, strong colony none observed. There were no queen symptoms.Sample of dead bees taken from affected hive, dead bees from an affected hive had positive detects for clothianidin, thiabendazole and thiamethoxam. Samples of live bees, taken from affected hive and live bees from an affected hive had no detected active ingredients. The weather at the time of the incident was Sunny, dry, windy at 10 to 20 knots moderate humidity, temp 18 to 23C. Prior to the incident, there were an average of 30 frames of bees, 6 to 8 frames of brood, and Honey - 14 and Pollen 6 to 8 frames of pollen and honey. After the incident, it was too soon to tell the average frames of bees, frames of brood and too soon to tell the frames of pollen and honey. It was too soon to tell if it got worse after the incident. No food given to the bees. In 2012, no treatments were applied to the hives. In 2013, no treatments were applied to the hives. Information on crops located near the beeyards: 120 ac of beans were adjacent from the beeyard. Corn was planted May 6th in the area. Evening of May 9th noticed hundreds of dead bees in one yard. This bee keeper is not registered with OMAFRA. Also notes indicate corn was planted Monday.

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