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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-3132

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.

Environment

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

12-MAY-12

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.

Active(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: x

  • Active Ingredient(s)
    • CLOTHIANIDIN
    • THIAMETHOXAM

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

Unknown

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).

Corn planted with air seeder. The conditions at the time of planting were windy from direction of planting, and the crop was planted 400m W from the beeyard.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform IV: Environment (includes plants insects and wildlife)

1. Type of organism affected

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Common name(s)

3. Scientific name(s)

4. Number of organisms affected

1200

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Death

7. Describe symptoms and outcome (died, recovered, etc.).

Bee mortality was observed on 2012-05-12 and was visited on 2012-06-04; a bee sample was collected on 2012-05-12, 2012-06-04. There were 16 hives in the bee yard, with 16 hives showing mortality. The estimated number of dead bees per colongy was 75 (800-1600 in total). The observed symptoms were dead bees at bottom on bottom board and in front of hive; bees did not seem aggressive, no shaking observed. Colony condition before incident strong, after incident was average. The state of the colony afterwards was unknown. Mite treatment in fall 2011 included 65% formic acid in fall 2011 and spring 2012. DEAD BEE SAMPLE. May 1 corn planted 200ft NW; May 20 soy planted 400ft N. Inside colonies not as much brood; four colonies queenless; no colonies dead. - Chemical treatments these colonies have received: - Oxytet 25S in fall 2011 and May 2012 (for afb) - 65% formic acid in fall 2011 and spring 2012 (for mites) - Fumagilin-B in fall 2011 (for nozema) - there is no disease in this yard right now (did have afb 3 years ago, but was treated and has been fine since) LIVE BEE SAMPLE. May 1 corn planted 200ft NW; May 20 soy planted 400ft N. Field to the west planted with corn May 11th and May 12th. Inside colonies not as much brood; four colonies queenless; no colonies dead. - Chemical treatments these colonies have received: - Oxytet 25S in fall 2011 and May 2012 (for afb) - 65% formic acid in fall 2011 and spring 2012 (for mites) - Fumagilin-B in fall 2011 (for nozema) - there is no disease in this yard right now (did have afb 3 years ago, but was treated and has been fine since)

8. a) Was the incident a result of (select all that apply)

Unknown

8. b) i) How many times has the product been applied this year?

Unknown

8. b) ii) What was the date of the last application?

Unknown

9. Did it rain

9. a) During application?

Unknown

9. b) Up to 3 days after application?

Unknown

10. a) Was there a buffer zone?

Unknown

10. b) What type?

Aquatic

10. c) What was the size of the buffer zone?

11. a) Were environmental samples collected and analysed?

Yes

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