Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-1977
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.
03-JUN-20
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: Unknown
PMRA Registration No. 32220
PMRA Submission No.
EPA Registration No.
Product Name: ENGENIA
- Active Ingredient(s)
- DICAMBA (PRESENT AS N,N-BIS-(3-AMINOPROPYL)METHYLAMINE SALT)
PMRA Registration No. 29643
PMRA Submission No.
EPA Registration No.
Product Name: VIOS G3
- Active Ingredient(s)
- TEMBOTRIONE
- THIENCARBAZONE-METHYL
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: ROUNDUP
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: corn
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
It was reported that tank mix application of the following pesticide products on a neighbouring field is supected: Engenia, Vios G3 and Roundup. From the analyzed samples, the following chemicals were detected: Amitraz, Benzovindiflupyr, Ethylene Thiourea.
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)
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.).
The effects were noticed almost immediately after an agricultural pesticide application. More than 2000 bees died. From the first affected hive, 230 of 260 adult colonies died. From the second affected hive, 324 of 424 adult colonies died.The surviving adult bees were crawling and disoriented. The queens exhibited unusual egg laying patterns/stopped laying eggs. There were dead larvae/pupae outside of the colony and spotty brood production.
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?
03-JUN-20
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?
Terrestrial
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