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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2241

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: Corn is located north, south, east and west of the beeyard, and neonictotinoids were used on the crop. Fungicide only corn directly to the W of holding yard. Neonic corn to the N, S and E of holding yard.

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


Reproductive impairment

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

There were a total of about 400 full colonies and 5 nuc colonies in the bee yard. All full hives were affected. There were an average of 8-10 frames of bees, 6 frames of brood, and about 4 (scattered) frames of pollen and honey. No pest were present in the affected bee year in the past year. Additional food sources provided to the bees included sugar syrup, and pollen supplement. Mite away quick strips were applied 1.5 weeks ago to the hives to treat. The antibotic oxysol was applied to the hives at the rate of 32gm, to treat American Foul Brood. 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 and a lack of foragers returning to hive. There were 0-500 dead bees observed with about 300 dead bees in front of the more affected hives, the bees were located outside hive. Queen symptoms included queen stopped laying, and unusual laying pattern. Additionally, Queens lay in the bottom of cell, not in the centre. The weather at the time of the incident was sunny, dry and breezy (S, SE, SW), temperature was 23-27C and humidity was moderate (70%?). The Last rain event occurred on 1.5 weeks ago. The Beekeeper believes neonictinoids at corn planting + neonicitinoids in dust cause the incident. Sample of dead bees taken had positive detects for clothianidin. Samples of comb pollen taken had positive detects for thiamethoxam, clothianidin, imidacloprid and acetamiprid.

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