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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2244

2. Registrant Information.

Registrant Reference Number: xx

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 was E and S of the beeyard, and was planted on 2014-05-12. Corn stubble to the south and to the east of bee hives

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 5 colonies in the bee yard (1 nuc). There were 5 affected colonies. There were an average of 16 frames of bees, 6 frames of brood, and 5-7 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; Varroa mite (hive 1 - 2mites, hive 2 - 1 mite , hive 3 - 1 mite). In May 2014, mite away quick strips were applied, and fall 2013, apistan was applied at label rate to the hives to treat varroa mite. In fall 2013 (3rd round to be applied in May 2014) the antibotic Oxytetracycline was applied to the hives at lable rate. Bees were actively foraging at the time of mortality observation and actively foraging when questionnaire being filled out (a bit). There were 50 dead bees observed outside the hive. no adult symptoms observed and the queens and brood wer in good health. The weather at the time of the incident was sunny and windy, temperature was 24 C. Thunderstorm late in day. Bee keeper believed Neonics were the cause of the incident. Bees south facing Sample of dead bees taken from outside the hive had positive detects for clothianidin. Water sample taken had positive detects for thiamethoxam and clothianidin. Dandelion taken had positive detects for thiamethoxam and the pollen comb taken had positive detects for thiamethoxam, clothianidin and imidacloprid. Sample of live bees taken 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