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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-4412

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: QUEBEC

6. Date incident was first observed.

07-JUN-11

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)
    • ATRAZINE (PLUS RELATED ACTIVE TRIAZINES)
    • CLOTHIANIDIN
    • FENITROTHION
    • THIAMETHOXAM

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: semis de mais et soya

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

L'incident est rapporte en periode de semis de mais et soya. Il est suspecte que le pesticide soit issu de semence enrobee de celui-ci. Le site du rucher est entoure de terres agricoles ou des semis de mais et soya sont en cours.

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)

Abeille

3. Scientific name(s)

APIS MELLIFERA

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

Death

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

25 colonies dans un rucher. Affiablissement note des colonies avec mortalite accrue d'abeilles devant celles-ci. Aucune colonie n'est morte, elles ont recuperees par la suite. Les premiers signes ont ete constates le 1er juin 2011 alors que l'echantillon d'abeilles mortes a ete preleve le 7 juin 2011. Il est soupconne une intoxication par exposition de poussieres de semis enrobe avec le pesticide en cause, la clothianidine ou le thiamethoxam (dont la clothianidinie est metabolite....). Des analyses d'abeilles mortes prelevees au devant des colonies affectees ont ete realisees avec les resultats suivant: Clothianidine: ,0004ug/abeille ),004 mg/kg) Thiamethoxam: ,00005ug/abeille (,0005 mg/kg) Fenitrothion: ,009ug/abeille (,09mg/kg) ; Atrazine: ,00006 ug/abeille (,006 mg/kg) La quantite de clothianidine represente 1/10 de la LD50 et est suspecte etre la cause des signes observes dans les colonies. Pour autre information si necessaire, me contacter: Nom, addresse, Numero de telephone.

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?

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)

13. Please provide supplemental information here