Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2260

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: About 8.5ha and 11ha of Corn was about 40m (S) and 100m (E) from the beeyard, and was planted on about 10-14 days prior to inspection. No pollinating vegetation nearby (that was observed). It was a very cool day on the day of inspection. The 3 most affected hives appeared quite strong when they were opened up. No poisoning symptoms were observed in any of the hives during the inspection. The beekeeper said all evidence of the event would have been washed away b/c of the rain. one of the hives that was opened was weak

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


Reproductive impairment

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

There were a total of 22 colonies in the bee yard. There were 3 affected colonies. There were an average of 3-9 frames of bees, 3-9 frames of brood, and alot of hives have no pollen. The following pests were present in the affected bee yard in the past year; varroa. Additional food sources provided to the bees included sugar syrup (barrel fed in fall after the last honey crop is harvested) and pollen supplement (on the hives right now, homemade). Formic acid pads (late summer 2013) and Apistan or Apivar (October 2013) was applied. On Oct 2013, the antibotic fumagilin-B and oxytetracycline was applied to the hives to treat nosema and AFB. 11/35 hives had winter dead outs. Bees were actively foraging when incident occurred, dead bees had pollen on their legs. There were 501-1000 dead bees observed outside of the hive (on the rugs in front of the hives). Adult bee symptoms included shaking/trembling/twitching and crawling. These are symptoms that were observed by (beekeeper) on May 21st, 2014 when the incident was first seen. Brood symptoms included Spotty brood production (some of the frames had a spotty brood pattern). No queens were observed in any of the hives that were opened. Bee inspector did not want to keep hive open too long - was 9 degrees, overcast + drizzly - did not want to hurt/freeze the bees so not much time was spent looking. The weather at the time of the incident was sunny and calm, temperature was 30 C+ (very warm). The Last rain event occurred on rained in evening of May 21st, 2014. very cool day (overcast, drizzley and ~9 C) on day of inspection - inspector was hesitant to open hives (given weather conditions) for fear of freezing the larvae -despite his concerns, 8 hives were opened up (it was warmer by the bush, where the hives were) - The 3 most affected hives appeared quite strong when they were opened up. no poisoning symptoms were observed in any of the hives during the inspection. A few hives had a few dead bees in front of them (on the ground) - these were not collected as there were not very many - A rain was recived through the night of May 21/14 - Bker was not present during the inspection, but he called when we were there : - BKer said all evidence of the event would have been washed away because of the rain. Samples of dead bees and comb pollen taken had positive detects for clothianidin. Sample of soil 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