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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2275

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: MANITOBA

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:Corn (150m away planted on 2014-05-24) and canola are SW from the beeyard, soybeans are 500m west and wheat is 700m east of the beeyard. All fields are tilled with some crop residue from previous year (minimal residue). Trees around bee yard were flowering which were bees main source of foraging material at time of incident. Wind direction was N at the time of planting (corn field S of 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 1 colony in the bee yard. There was 1 affected colony. There were an average of 15 frames of bees, 12 frames of brood, and 5 frames of pollen and honey. The following pests were present in the affected bee yard in the past year; Chalkbrood, wax moth, nosema, varroa mite and skunks. Additional food sources provided to the bees included sugar syrup and pollen supplement (patty) in the spring 2014. In fall 2013, apivar was applied at a rate of 2 strips to treat varroa mites. In the fall 2013 the antibotic fumagillan-B was applied to hive, oxytetracycline was applied in the spring 2014. the rodenticides jaguar (26673) was used in Fall/winter 2013. Placed bait under hive during winter to kill any mice in/around bee box. Bees were actively foraging when incident occurred and when questionnaire was being filled out. There were 0-500 dead bees observed outside the hive. Adult bee symptoms included shaking/trembling/twitching, crawling and disoriented. Brood symptoms included dead larvae/pupae on bottom board. no queen symptoms observed. The weather at the time of the incident was sunny and not overly windy - maybe light breeze, temperature was 10-12 C. The last rain event occurred on 2014-05-25 (AM). Beekeeper was unsure what caused the incident - but potentially seed treatment used on corn on field to the south. field south of bee yard was seeded on Saturday, May 24, 2014 with corn. Saturday was a very windy day. Wind was blowing from the south so dust from the field was moving from seeded corn field directly north into the bee yard. Bees were observed on SUnday, May 25, 2014 with no unusual symptoms. weather was cool and damp so bees had low activity. Symptoms of dead bees and affected bees were observed on Monday, May 26, 2014 around 11:00am. Beekeeper observed dead bees at the entrance and out side of the hive. Also noticed bees twitching and crawling around the hive and in the grass. Hive had come out over winter strong with no noticeable disease or trouble. therefore, beekeeper thought it could be related to corn seeding so phoned provincial specialist. Sample of dead bees taken had positive detects for thiamethoxam and clothianidin. Sample of live bees 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