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: 2013-3667

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


Reproductive impairment

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

There were a total of 12 colonies in the bee yard. There were 8 affected colonies. There were 2 to 3 cups of dead bees in front of each hive observed outside of hive.Bees were actively foraging at the time of the incident. No adult symptoms. Brood symptoms noticed no eggs in two hives. Queen symptoms included a queen that stopped laying. Sample of dead bees taken from affected hive had positive detects for clothianidin, thiabendazole and thiamethoxam. The weather at the time of the incident was sunny, dry and windy. Prior to the incident, there were an average of > 10 frames of bees, 4 - 5 frames of brood, and 3 - 4 frames of pollen and honey. After the incident, it was too soon to tell the average of frames of bees, too soon to tell the frames of brood, and too soon to tell the frames of pollen and honey. No food given to the bees. In 2012, the following treatments were applied to the hives: formic acid. In 2013, the no treatments were applied to the hives. It is unknown when the following treatments were applied to the hives. Not too sure what crop was planted could be corn or soybeans. 1 yard with 8 hives, 2 to 3 cups of bees in front of each hive on May 17th following soy bean planting in adjacent field. Additionally mortality noticed May 21st following corn planting in surrounding fields. Beekeeper collected a sample. Bees were actively forgaing at the time of the case. No eggs were noted in two hives, The queen had stopped laying eggs. The weather was sunny and dry and windy and had no humidity. No disease or pest were noted on the bees. It was hard to discern the health of the hive after the honey bee case since the incident just occurred. No additional food source was provided to the bees. Treament for pests and disease occurred both in the Fall and Spring. Corn and soybean fields were found to surround the yard and may have just been planted.

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