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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-3672

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 4 colonies in the bee yard. There were 2 affected colonies.There were 0 - 500 dead bees per colony. Dead bees were observed outside the hive. Bees were in hive, it was cold outside. Adult bee symptoms included crawling. Some crawling maybe due to the cold. No brood symptoms were observed.No queen symptoms were observed.Sample of water, taken from steam 100m east of hives, had positive detects for thiamethoxam.Sample of pollen taken from strong hive, comb sample from least affected hive (control), had positive detects for clothianidin and thiamethoxam. Sample of pollen taken from affected hive, comb sample, had positive detects for clothianidin and thiamethoxam. Sample of dead bees taken from affected hive, composite sample, had positive detects for clothianidin and thiamethoxam.Samples of live bees taken from strong hive, collected from least affected hive (control sample), had no detected active ingredients. The weather at the time of the incident was Windy, temp 11C, cold day. Prior to the incident, there were an average of 7 frames of bees, 7 frames of brood, and 3 frames of pollen and honey. After the incident, there were an average of 7 frames of bees, 7 frames of brood, and 3 frames of pollen and honey. The previously noted disease or pests did not get worse after the incident. Additional food sources provided to the bees included sugar syrup (fall) and pollen supplement (spring). In 2012, the following treatments were applied to the hives: formic acid, amitraz.Information on crops located near the beeyards: 200 ac of corn was located 3 m from the beeyard, and was planted on 2nd week in May. Other crops in the area include corn planted all around however the area has some tobacco and wheat.Beekeeper reported 1 to 2 hives out of 4 or 5 yards are getting weak and that two hives have lost queens. Beekeeper noted that there are only a few dead bees. Bees were actively foraging at the time of case. Bees were crawling and disoriented and dead bees were found at the front of the hive. Loss of brood noted in 4 hives. Queen did stop laying eggs. Samples were collected. The general health of the affected yard did not change significantly before and after the noted case. No pests or disease was noted in the bees. Bees were fed additional food sources. Treatment for pests/disease did occur in the Fall of 2012, none noted in the Spring of 2013. Corn and soybean are crops that surround this bee yard, along with forest.

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