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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-2266

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.

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.

24-MAY-14

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

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).

Dead bee samples collected on Monday and Tuesday morning. Fields surrounding the beeyard were being worked on to the north (Monday) and south/west (Saturday & Sunday) and south/east (Tuesday).

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)

Honey Bee

3. Scientific name(s)

Unknown

4. Number of organisms affected

Unknown

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.).

There were a total of 2 colonies in the bee yard. There were 2 affected colonies. There were an average of 5.5 frames of bees, 5 frames of brood, and 2.5 frames of pollen and honey. No additional food sources given, just purchase, new BK only in operation for 3 weeks. Bees were Actively foraging when incident occurred;and actively foraging when questionnaire being filled out. There were 0-500 dead bees observed outside of each hive. shaking/trembling/twitiching, crawling, disoriented, and tongues sticking out. no brood or queen symptoms observed. The weather at the time of the incident was sunny, dry and windy on monday from the south, temperature was 25 C. Beekeeper believes planting of corn was occuring close by, beekeeper heard the hum of an airseeder on Saturday + Sunday. Sample of dead bees taken had positive detects for clothianidin.

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?

No

9. b) Up to 3 days after application?

No

10. a) Was there a buffer zone?

No

10. b) What type?

Aquatic

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

11. a) Were environmental samples collected and analysed?

No

To be determined by Registrant

12. Severity classification (if there is more than one possible classification, select the most severe)

Minor

13. Please provide supplemental information here