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: 2015-2263

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).

Area has mainly large acreage of corn/soy/winter wheat. Mennonite farmers to south, rest is conventional cash cropping. Corn immedately across rd in 2013. Pre-plant.

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 7 colonies in the bee yard. There were 3 affected colonies. There were an average of 5 to 7 frames of bees, 3 to 4 frames of brood 6 to 8 in circle. Hives not apart, in dead outs old pollen still in frames, new pollen heavy. no pests in the past year (some viral in spring-normal). Additional food sources provided to the bees included; Fall: Sugar syrup and pollen substitute (icing and feed bees) all summer, April 10 or earlier: Sugar syrup, Mar 11: Bakers dried-invert sugar feed bee as pollen substitute. In midsummer, Mite Away Quick Strips were applied to the hives. In fall 2013 the antibotic Oxytetracycline was applied to the hives by adding to icing suger in the fall. Bees were Actively foraging on Saturday and one dead bee had pollne on legs. There were 10-15 (on/off) dead bees observed outside of each hive. Adult bee symptoms included shaking/trembling/twitiching, crawling,. Additionally, they were partially paralyzed. No brood or queen symptoms observed. The weather at the time of the incident was sunny, overcast, temperature was 10-20 C. The last rain event occurred on 2014-04-22. Beekeeper believes Neonics caused the incident. old pollen in dead - out (new frames), dark pollen, 2 frames per hivelike this, queen issues? -Bees somewhat aggressive (poor weather?) , 5 frames of bees per hive, brood ok, somewhat spotty, no mite wash, too windy/cold -feed bee - pea meal, high protein, pollen supplement, mixed with icing sugar. Sample of dead bees taken had positive detects for imidacloprid. Samples of comb pollen taken from affected hive 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