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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2240

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: 5ac of corn was 150m and south of the beeyard and a 40ac of corn was 250m and south west of the beeyard. Initial mortality first observed on May 9th and corn planting said to have taken place on May 8th, by the beekeeper. Beekeeper thinks that corn was planted near hives on May 8th, 2014.

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


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

There were a total of 95 colonies in the bee yard. Almost all colonies to some extent were affected. There were an average of 7-8 frames of bees, 4-5 frames of brood, and 3 frames of pollen and honey. No pest were present in the afected bee yard in the past year. Additional food sources provided to the bees included sugar syrup, started with sucrose and just switched to fructose. On March 28 (strips used for a couple of days), Apivar were applied to the hives to treat varroa mite. The antibotic Oxytetracycline (Oxysol 6205) were applied to the hives in Three treatments 1) 2 weeks ago 2) 1 week ago and 3) 'today' (32 grams/treatment), to treat AFB (American Foul Brood). The bees were actively foraging when mortality observed, dead bees had some pollen on their legs, after the adverse effects there was a noticeable decline in foraging, lack of foragers returning to hive (lost some foraging force). Some dead bees had tongues and stingers hanging out. There were 0-500 dead bees observed inside and outside the hive. Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented, stumbling, tongues hanging out, stingers hanging out. No queen or brood symptoms observed. The weather at the time of the incident was sunny and light wind from the south, temperature was 20C (moderate and nice). The Last rain event occurred on maybe 2-3 days before. Beekeeper believes Corn planting near hives caused the incident. Samples of dead bees taken had positive detects for Clothianidin.

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