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: 2015-2270

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 3ha of Hay was about 20m E of the beeyard. Bee yard is located on W side of lane going into residence at xxx. The W side of the bee yard is bordered by a bush. To the S is a scruff grass area and lawn/buildings. To the E (other side of lane) there is a hay field; other hay/pasture fields boarder this hay field to the E & S. Some flowering vegetation was observed in the area around the bee yard (eg: bird for trefoil). A canola field could also be seen in the distance to the SE; the BK thought the bees could getting exposed to pesticides in this canola field.

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 26 colonies in the bee yard. There were 1 affected colonies. Bees were actively foraging when questionnaire being filled out. There were dead bees observed outside of the hive. Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. no brood or queen symptoms occurred. All 5 hives that were opened during the inspection had queen cell cups in them; it was unclear as to why they were in there (ie, new colonies or just added as "insurance"). The beekeeper believes neonics were the cause of the incident. Beekeeper reported dead/affected bees and disoriented queen outside of the hive at this yard. Affected hive was opened, a queen was found and a good brood pattern was observed. the hive did not appear very strong; may be a nuc? did not take samples from this hive. -No dead/affected bees were observed in front of any of the hives in this yard. -It was warm sunny day for the inspection - the bee were actively foraging and bringing a lot of yellow pollen in; the pollen was believed to be coming from the canola field to the south east of the yard - A pollen sample and hive bee sample was taken from the coner hive (closest to the canola field). the bee inspector said that ill effects (from 'poison' coming into the yard) would most likely be observed in the corner hives first as they will pick up all of the stragler bees coming home with a 'full load' of pollen. - a soil sample and a flower/vegitation sample were taken from the canola field located ~1.4Km SE of the bee yard. the field was in bloom (maybe a bit past full bloom), but was filled of bees. Samples of live bees, and pollen comb taken had positive detects for clothianidin. Canola vegetation taken had positive detects for thiamethoxan and clothianidin. No positive detects were seen for soil sample taken.

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