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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2247

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 was W of the beeyard, and was planted before Wednesday. Corn planted to the west of the bee 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

Abnormal behavioural effects


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

There were a total of 8 colonies in the bee yard (4 nucs). There were 8 affected colonies. There were an average of 5.5 frames of bees, 3.3 frames of brood, and 6 frames of pollen and honey. 0 mites from 4 hives, nothing found during provincial inspection. Mite away quick strips, (to be done in may 2014) and apistan were applied to treat varroa. In fall 2013 (3rd round to be applied in May 2014) the antibotic oxytetracycline was applied to the hives at label rate. Bees were actively foraging at the time of mortality observation and lack of foragers returning to hive. There were unknown amount of dead bees observed inside and outside the hive. Adult bee symptoms included dead drones - paralyzed. no brood symptoms observed. no queen symptoms observed, healthy queens except hive 2, dead queen, possibly due to yesterday's inspection. The weather at the time of the incident was sunny, temperature was 18 C. The Last rain event occurred on 2014-05-17. Beekeeper believes neonics was the cause of the incident.Samples of dead bees taken from hives 1-4 had positive detects for clothianidin and coumaphos. Sample of water from down stream of the yard and dandelion taken had positive detects for thiamethoxam and clothianidin. Sample of comb with pollen taken had positive detects for clothianidin, thiamethoxam and imidacloprid. sample of water at laneway 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