Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-4510

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.

08-JUL-24

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: SPINOSAD (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • SPINOSAD

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: OXALIC ACID (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • OXALIC ACID

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: FORMIC ACID (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • FORMIC ACID

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: METHOXYFENOZIDE (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • METHOXYFENOZIDE

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: CHLORANTRANILIPROLE (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • CHLORANTRANILIPROLE

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PMRA Registration No.       PMRA Submission No.       EPA Registration No.

Product Name: GLYPHOSATE (UNSPECIFIED FORMULATION)

• Active Ingredient(s)
  • GLYPHOSATE

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7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

30000

5. Description of site where incident was observed

Fresh water

Terrestrial

Agricultural

Salt Water

6. Check all symptoms that apply

Abnormal behavioural effects

Death

Impairment of health

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

Cas d'empoisonnement d'abeilles domestiques en pollinisation de canneberge. Effets soudains (evenement soudain et marquant a l'origine d'un nombre eleve d'abeilles mortes ou d'abeilles manquantes ou observation d'un changement a la sante de la colonie). Nombre de colonies adultes atteintes: 6 sur 9 d'inspectees. Nombre de colonies adultes mortes: 1 sur 9 d'inspectees, une 2e colonie en faisant un suivi avec l'apiculteur. Baisse remarquable du butinage après manifestation des effets nocifs. Emplacement des abeilles adultes mortes: A l'interieur et a l'exterieur et l'autre mortalite aigue a l'entree ou devant la ruche faisant signe d'empoisonnement aux pesticides dans les Ruches [nombre], [nombre], [nombre], [nombre], [nombre] et M1. Mortalite de l'entierete des abeilles adultes devant et dans la ruche [nombre]. Nombre moyen d'abeilles adultes mortes par colonie: plus de 2000. SYMPTOMES DES ABEILLES ADULTES VIVANTES: Tremblements/secousses musculaires et abeilles rampantes. Environ 10 abeilles vivantes restantes sans poil, lentes dont une agonisante (sur le cote) dans la ruche [nombre]. SYMPTOMES DE LA REINE: Reine morte. Pesticide isole en laboratoire. Empoisonnement par des pesticides : Un echantillon d'abeilles mortes congelees preleve le 11 juillet 2024 presentent des concentrations elevees d'un insecticide extremement toxique chez les abeilles, le spinosad. Nul doute que dans ce cas, l'insecticide est en cause dans la mortalite des abeilles observee dans le rucher. Les analyses ont ete réalisees au Laboratoire d'expertises et d'analyses alimentaires du [Organisation].Voir piece jointe pour plus details avec le consentement de l'apiculteur pour la divulgation des informations.

8. a) Was the incident a result of (select all that apply)

Application

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)

Minor

13. Please provide supplemental information here