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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2250

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 5ft and east of the beeyard. Lots of cash crops in area (corn, soy) planted over last 2 weeks with vacuum planter. It was very windy and dusty last weekend. South of the yard, there were fruit trees which were in blossom last week. Hawthorne trees were in flower NE of 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

Abnormal behavioural effects


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

There were a total of 3 colonies in the bee yard. There were 3 affected colonies. Bees were strong coming out of spring, hive 1 very strong, hive 2& 3 less. good brood pattern in all 3 hives. ok number of frames for brood and pollen and honey. The following pests were present in the affected bee yard in the past year; AFB detected during inspection June 4th, 2014.Very low fall 2013, Varroa mite wash. Additional food sources provided to the bees included sugar syrup (spring) and pollen supplement. In the spring, formic acid was applied. In the fall the antibotic oxytetracycline was applied to the hives. Bees were actively foraging when questionnaire being filled out, and after the adverse effects there was a noticeable decline in foraging. There were about 250 dead bees observed outside of each hive. Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented, tongues out - observed in dead bee samples and in live bees in hive 1. no brood or queen symptoms were observed. The weather at the time of the incident was sunny and windy, temperature 25C and humid. the bee keeper believe neonic were the cause of the incident. Samples of dead bees and comb pollen 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