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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2271

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: 50+ ac of corn was 200 E of the beeyard. 20+ of corn was 20m west of the beeyard, and 50+ ac of corn was 100m South of the beeyard. Additionally, pasture to corn east of bee yard, Hay to the west as well. 30ac, 20 m away, Hay to corn south of beeyard. There is bush 10 m to the north of the bee yard (50 + ac).

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 39 colonies in the bee yard. There were 39 affected colonies. There were an average of 9 frames of bees, 9-10 frames of brood, and 1-2 frames of pollen and 3 frames of honey. Additional food sources provided to the bees included sugar syrup. Mite Away quick strips, oxalic acide and apivar were applied to the hives. In the spring 2014, oxtetracycline was applied in 4 treatments to treat AFB, EFB. Bees were actively foraging when incident occurred and when questionnaire was being filled out. There were 0-500 dead bess observed outside of each side. Adult bee symptoms included crawling and disoriented. no brood symptoms were observed. Queen symptoms included failure of colony to re-queen on its own and failure of purchased queen to establish. Nucs were introduced in spring to this year. No unusual weather events. the beekeeper believes Insecticide (neonic) from treated field corn seed were the cause of the incident. Samples of live bees and raw pollen had positive detects for acetamiprid. samples of comb pollen had positive detects for imidacloprid. sample of vegetation (anthers with pollon from corn) 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