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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2255

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).

soybeans planted across road on June 7 or June 8. June 5 - soybeans planted behind hives (gravity planter). June 8 - new incident noticed. Affected drones (penises sticking out). Still ongoing (as of June 18) but not as bad as the initial event.

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 14 colonies in the bee yard. There were 14 affected colonies. Additional food sources provided to the bees included sugar syrup. In the fall, apivar was applied at 2 per hive to the hives to treat varroa. In the Fall the antibotic Terramycin was applied to the hives and fed with lard patties, to treat American foulbrood. Bees were Actively foraging at time of intial mortality. There were 0-500 (about 1 cup total) dead bees observed outside of each hive. Adult bee symptoms included proboscis hanging out. Drones with penis' sticking out. The weather at the time of the incident was sunny, dry and wind coming from the south (10kn/hr), temperature was 18 C and was humid. Nice all weekend too. Beekeeper believes' physical drift from a planted corn field. no foraging occurred at the planted field. Samples of dead bees and comb pollen taken 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