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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3669

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 8 colonies in the bee yard. There were 8 affected colonies. The number of dead bees per colony observed outside the hive was unknown at the time.No adult bee symptoms observed. No brood symptoms observed. Queen symptoms included dead queens. Additionally, the beekeeper did not have details for this yard, he says many queens were lost this year.Samples of water taken from water from yard had no detected active ingredients. Samples of live bees taken from unaffected hive, unaffected live bees from yard had no detected active ingredients. Sample of dead bees taken from affected hive, dead bees from affected yard had positive detects for clothianidin and thiamethoxam. The weather at the time of the incident was unknown. Prior to the incident, there average number of frames of bees is unknown, unknown number of frames of brood, and unknown number of frames of pollen and honey. The following pests were present in the affected bee yard in the past year is unknown. After the incident, the average number of frames of bees was unknown, unknown number frames of brood, and unknown number of frames of pollen and honey. It is unknown if the previously noted disease(s) or pest(s) got worse after the incident. It is unknown the additional food sources provided to the bees. In 2012, the following treatments were applied to the hives was unknown. In 2013, the following treatments were applied to the hives was unknown. It is unknown when the following treatments were applied to the hives. Other crops in the area include corn, bush and a pond are located adjacent to the yard, the corn across the road is 2 inches tall while the corn next to the bee yard is 1 inch tall.5 yards were inspected by OMAFRA inspectors. Initial call (May 17): crazy stuff around bee hives last 2 days, not sure what to do. Twitching bees. 5-6 yards noticed so far out of 110 yards. More noticeable early in the morning. Dead drones out front twitching. Moved hives. Affected hives near moved a lot of corn area. 40-50 bees/hive, 10-12 hives per yard. drones being pushed.

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