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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2237

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Country: 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: x

  • 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).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

Information on crops located near the beeyards: bee yard is surrounded by hay fields. A site visit was not conducted for this incident, was not reported to OMAF.

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)


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 35 colonies in the bee yard. 50% of full hives and 30% of nucs were affected. There were an average of 7-8 frames of bees in full size hives and 3-4 frames in nucs, 5 frames of brood in full hives and 3 in nucs, and 2.5 frames of pollen and honey in full hives and 1 in nucs. The following pests were present in the affected bee yard in the past year; Chalkbrood, Varroa mite and assumed Nosema. Additional food sources provided to the bees included sugar syrup (fall 2013) and pollen supplement (spring 2014). In spring and fall 2013, oxalic acid was applied at label rate and in spring 2014, apivar was applied at label rate to the hives to treat Varroa mite. In the spring (3x) and fall (3x) of 2013 and the spring (3x) of 2014 the antibotic oxytetracycline was applied to the hives to treat AFB (american foul brood). The bees were actively foraging when the incident occurred. There were 40-50 dead bees observed outside the hives. Queen and brood were not checked for symptoms. Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented, tongues extended and laying on sides/backs.The weather at the time of the incident was sunny and warm. Beekeeper believes this yard experienced a light exposure to neonics. Samples of dead bees taken had positive detects for clothiandian

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