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: 2015-2265

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).

Information on crops located near the beeyards: >100ha of soybean was 20-25m west of the beeyard, and was planted on 2014-05-26.Other crops in the area include >150 of corn which was 25m from the beeyard, and was planted on 2014-05-21 and 2014-05-22. Soil type: clay, tilled. Swamp to the east of the bee yard. Bee yard on 2 acre natured tree lot. Surrounded by farm field where crop rotation types are corn and soubean. At the time of visit, soubean was being planted (treated seed with air planter) to the west. Bee kill appears to have coincided with the north corn field planting.

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 25 colonies in the bee yard including 15 nucs. There were 25 affected colonies. There were an average of 9 frames of bees, 6 frames of brood, and 3 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; AFB, varroa mite. identified an active case of AFB in at least 8 hives. Additional food sources provided to the bees included sugar syrup. The following mite treatments were applied to the hives; formic acid (65%): Aug - 2013, made pads, and formic acid (65%): Nov/Oct 2013, mixed as sugar syrup. On May 25th the antibotic oxytetracycline was applied to the hives as powder (23g/hive) mixed with icing sugar, to treat AFB. Bees were actively foraging when incident occurred;actively foraging when questionnaire being filled out, after the adverse effects there was a noticeable decline in foraging. There were 0-500 dead bees observed outside of each hive. Adult bee symptoms included Aggressive, shaking/trembling/twitching, crawling, disoriented. The weather at the time of the incident was sunny and calm, temperature was 17-20 C and humidity was moderate. Beekeeper believes Timming of corn seed planted on north farmer field around may 21/22, 2014 coincided with bee kill. Beekeeper only had one hive at this beeyard site in 2013 - 2014 beekeeper has 23 hives at the beeyard site - bee inspection identified 8 AFB hives at this beeyard site on May 26, 2014. Samples of dead bees taken had positive detects for clothianidin. Apple blossom samples taken had positive results with thiamethoxam and clothianidin. Samples of water taken 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