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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2242

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 fields are east and west of the beeyard the west field is 300ac and was planted on 2014-05-26, the eastern filed was planted on 2014-06-01.Corn planting to the west started on Monday May 26 (AM). Effects will be in the next week or two. On June 18, Effects were ongoing in Hive #2 (most affected hive). Queen not laying, brood being replaced by pollen. First week was the worst for dead bees but it is still ongoing.

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


Reproductive impairment

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

There were a total of 2 colonies in the bee yard. There were an average of 14 frames of bees, 12 frames of brood, and 6 frames of pollen and honey. In the fall, Mite Away Quick Strips was applied. Last spring the antibotic oxtetracycline were applied to the hives to treat nosema. The bees were actively foraging when incident occurred; actively foraging when questionnaire being filled out and dead bees had pollen on their legs (some). There were 0-500 dead bees observed outside the hive. Adult bee symptoms included shaking/trembling/twitching and disoriented. Brood symptoms included some brood being thrown out on Monday (May 26). The weather at the time of the incident was sunny and wind from the south, temperature was 25C (warm) and humid. Effect were ongoing in Hive #2 (most affected hive ). Queen not laying. Brood being replaced by pollen.First week was the worse for dead bees but it is still on going. Samples of dead bees taken had positive detects for thiamethoxam and 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