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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-3675
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.
11-MAY-13Product 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: unknown
- Active Ingredient(s)
- CLOTHIANIDIN
- THIABENDAZOLE
- 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).
Site: Unknown / Inconnu
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)
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
Reproductive impairment
7. Describe symptoms and outcome (died, recovered, etc.).
There were a total of 14 colonies in the bee yard. There was 1 affectd colony and 10 dead colonies. There was between 0 and 500 dead bees per colony observed outside the hive.There was pollen on the back of the bee legs. Adult bee symptoms included shaking, trembling, twitching, disorientation, and paralysis. There was approximately 25% colony loss across the yard. Brood symptoms included an overall decline in brood production, additionally the brood appeared milky with fewer than normal cells.Sample of dead bees taken from affected hive, the dead bees collected by (name) from affected home yard (small sample) had positive detects for clothianidin, thiabendazole and thiamethoxam. After the incident, there was an average of 6 frames of bees, 3 double frames of brood, and 8 frames of pollen and honey.
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?
Unknown
