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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

Update the report

Incident Report Number: 2012-3949

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.

16-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:

  • Active Ingredient(s)
    • CLOTHIANIDIN
    • COUMAPHOS

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).

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)

Unknown

3. Scientific name(s)

Unknown

4. Number of organisms affected

18000

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

Death

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

Bee mortality was observed on 2012-05-16 and was visited on 2012-05-17; a bee sample was collected 2012-05-17. There were 40 hives in the bee yard, with 30 hives showing mortality. The estimated number of dead bees was average from 600 to thousands - 5 were really bad. The observed symptoms were A lot were still alive, were not going anywere, no fluttering wings, rolling around in a super, lots of food stores on the colony, the dandelion flow at the time was phenominal, A bee fell right out the sky and could not get up, it's like nothing I've seen before, no doubt in my mind that it was the neonicotinoids, had to requeen the whole yard.The state of the colony afterwards ... they are recovering now, the were requeened and they were not able take advantage of the spring flow, on their way back now, not prolific like they should be, it will take a bit more time Mite treatment in fall 2011 included Apivar. Mite treatment in spring 2012 included Apivar.

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?

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