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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2243

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: xx

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 was W, E and SE of the beeyard, and Beekeeper believes corn was planted Thursday, May 8 and Friday, May 9.

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 4 colonies in the bee yard (including 1 nuc). There were 4 affected colonies. There were an average of 13 frames of bees, 3 frames of brood, and 3.5 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; Varroa mite (1 mite found in hive #3). In fall 2013, apistan was applied at label rate to the hives to treat varroa mite. Mite Away Quick strips to be done in May 2014. In fall 2013 (3rd round to be applied in May 2014) of the antibotic oxytetracycline were applied to the hives at the label rate. Bee were actively foraging at the time of mortality observation. On Saturday May 3rd 50 dead bees, Monday May 12th 50 dead bees, Wednesday May 14th 25 dead bees observed outside of the hive (dragging out adult bees). No adult, brood or queen symptoms. The weather at the time of the incident was sunny and very windy, temperature was 20 C. storm occurred last night. the beekeeper believed neonicotinoids were the cause of the incident. beekeeper stated; long time to build up and weather poor, so hives are not taking off as expected.Samples of live bees and dead bees taken had positive detects for clothianidin. Samples of pollen in comb and dandelion taken had positive detects for clothianidin and thiamethoxam. sample of water taken from the creek had no detected active ingredients.

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