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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2253

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 located North and East of the beeyard, and was planted on 2014-05-31 and last week.

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)

Honey Bee

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. There were an average of 12 frames of bees in the weakest, 20 frames of bees in the strongest, 6-7 frames of brood in the weakest and 12-13 frames of brood in the strongest, and 6-7 frames of pollen and honey. In October (fall), Mite Away Quick Strips was applied at 2 per hive to the hives to treat Varroa. The antibotic oxytetracycline was applied to the hives at 3 application at recommended rate 5 days apart, to treat foul brood. Bees were Actively foraging when incident occurred, actively foraging when questionnaire being filled out, dead bees had pollen on their legs, after the adverse effects there was a noticeable decline in foraging, There's "probably" a lack of foragers returning to hive. There were 501-1000 dead bees observed outside of each hive. Adult bee symptoms included crawling and disoriented, brood and queen symptoms not observed yet. The weather at the time of the incident was sunny and very windy, temperature was mid 20's (dry) and humidity was average. The Last rain event occurred 7 days ago. Beekeeper believes neonics from corn planted to teh south and east of the bee yard. Samples of dead bees taken had positive detects for clothianidin. Samples of comb honey and vegetation (hawthorne) taken had positive detects fopr clothianidin and thiamethoxam. sample of comb pollen 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