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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2272

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): xx

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 is surrounding and 30-50m from the beeyard. The north field was planted on May 10-20th. Lots of treed fence rows with weeds and flowers for foraging surrounding bee yard

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 16 (2 failures) colonies in the bee yard. There were 16 affected colonies. There were an average of 17.2 frames of bees, 6 frames of brood, and 8.9 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; varroa mite (hives 1 & 2). Additional food sources provided to the bees included sugar syrup (until May 31) and pollen patties until end of June. In fall 2013 and July 2014, Mite Away Quick Strips were applied at 2 treatments to the hives to treat Varroa. The bees were actively foraging when incident occurred and actively foraging when questionnaire being filled out. there was a lack of foragers returning to hive. There were 0-500 dead bees observed. Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. Brood symptoms included; spotty brood production and covered brood cells with propolis. Queen symptoms included; unusual laying pattern, and queens do not seem to know how to lay properly. The weather at the time of the incident was sunny and higher than normal humidity. BeeKeeper stated that he believes that the neonic seed treatment on corn and soybeans is everywhere, and is contaminating all the pollen sources for the bees. -Beekeeper also stated that the bees have capped over pollen in the frames that is contaminated with neonic residue, Bee keeper stated that he believes the frame wax is also contaminated and the honey as well. Samples of dead bees taken had positive detects for thiamethoxam and phosmet. A sample of capped pollen comb had detects for thiamethoxam and Imicloprid.. Sample of pollen comb and live bees 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