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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2015-2258

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: x

Nom du titulaire (nom légal complet, aucune abbréviation): x

Adresse: x

Ville: x

Pays: x

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.


4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

5. Lieu de l'incident.



6. Date de la première observation de l'incident.


Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation.

Nom du produit: x

  • Matière active

7. b) Type de formulation.

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?


9. Dose d'application.


10. Site d'application (choisir tout ce qui s'applique).

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

Information on crops located near the beeyards: Crops were planted on 2014-05-17. The area surrounding is heavily cropped with ginseng, vegetable crops, white beans, corn and soy. Heavy ag chemical use in the area because of variety and timing of crops. Soil is sandy. Used to be tobacco producing land in this county. Corn was planted in alternating strips adjacent to hives on sat may 17th, 2014. seed was pink. No seed exposed. Planted using a vacuum planter (air-assist).

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?


Sous-formulaire IV : Environnement (y compris les plantes, les insectes et la faune)

1. Type d'organisme touché

Terr. Invrtbrt-Honey Bee/Inv.Ter-Abeille

2. Nom(s) commun(s)

Honey Bee

3.Nom(s) scientifique(s)

4. Nombre d'organismes touchés


5. Description du lieu où l'incident a été observé:

Eau douce



Eau salée

6. Cocher tous les symptômes qui s'appliquent à:


7.Décrire les symptômes et issue (mort, rétablissement, etc.).

There were a total of 12 colonies in the bee yard. There were 12 affected colonies. Number of frames of bees, brood and honey are on track for this time of year. The following pests were present in the affected bee yard in the past year; varroa mite (high levels august 2013). Additional food sources provided to the bees included Pollen supplement (on hives now) and sugar syrup (only if needed in spring). In fall 2013, Mite wipes and oxalic acid were applied and apivar was applied in the spring of 2014. In Fall the antibotics fumagilin-B and oxytetracycline were applied to the hives, oxytetracycline was also applied in the spring. Bees were actively foraging when original mortality was observed, actively foraging when questionnaire being filled out, and lack of foragers returning to hive. too soon to tell if after the adverse effects there was a notieable decline in foraging. There were ~300 visible, more were likely scavenged by insects dead bees observed outside of each hive. dead bees had tongues out, no pollen on legs, quite fresh, fuzzy. Have not been rained on (would have dies within 24hrs of inspection). Adult bee symptoms included shaking/trembling/twitching, crawling, disoriented, vomit/regurgitation. Additionally, tongues out (dead), some crawling, clinging to grass, twitching on back. Brood symptoms included spotty brood production (in one hive) and very minor amount of chalkbrood being dumped out of hive. Queen symptoms included unusual laying pattern (hive 5 observed) - pollen & nectar mixed in with capped brood, odd. other than that no queen symptoms observed. The weather at the time of the incident was sunny, temperature was between 10-20 C. Rained on and off all week. Beekeeper believes In general, had very high over winter losses and the hives are having trouble building up- pesticides are playing a role. there was heavy frost the last 2 nights, so eaves/blossoms don't like healthy but majority were already pollinated - apples will survive. -Bumble bees and other pollinators have been working flowers, but honey bees not as much. 12 hives arrived last week (Tues - wed), and will stay until approx. May 25. no insecticides have been sprayed yet -flowers are in various stages of bloom (good for bees and apples). Sample of dead bees taken had positive detects for clothianidin and myclobutanil. Sample of pollen comb taken had positive detects for clothianidin and acetamiprid. General Notes from Discussion with [name] (BKer) - In 2013 spring @ Home Yard, there were 600 hives and 5 barrels of sugar syrup. No bees were foraging. At other yards, the bees were thick in the air. 2014: - first- pass of over-winter loss checks had 50% loss, second pass showed 85-90% winter loss. - High levels of mites in the Fall 2013. Hives were all treated (see section 6) -no mite found during this inspection

8. a) Est-ce que l'incident a été causé par (coucher tout ce qui s'applique) :


8. b) i)Combien de fois le produit a-t-il été appliqué cette année?


8. b) ii)Date de la dernière application


9. Est-ce qu'il a plu

9. a) Pendant l'application?


9. b) Jusqu'à 3 jours après l'application?


10. a)Y avait-il une zone tampon?


10. b) De quel genre?

10. c) Quelle étaite la taille de la zone tampon?

11.Est-ce que des échantillons ont été recueillis dans l'environnement et analysés?


À être déterminé par le titulaire

12.Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

13.Donner des renseignements additionnels ici