ENS Event | |
|---|---|
21:00 Oct 14, 2009 | |
| Title | Patient Received Approximately 76% of the Prescribed Dose |
| Event Description | A three year old boy was undergoing a palliative treatment for a cancer related illness with I-131. The boy was prescribed 180.5 milliCuries of I-131 by his physician. During the treatment, a technician noticed that there were air bubbles in the intravenous tubing leading to the boy and stopped the treatment. Upon subsequent investigation, it was revealed that the patient only received 138 milliCuries of the prescribed 180.5 milliCuries of I-131, which is approximately 76% of the prescribed dose. The patient's physician has been notified, and is making a decision whether to inform the boy's parents. The licensee is investigating the cause of the incident.
A Medical Event may indicate potential problems in a medical facility's use of radioactive materials. It does not necessarily result in harm to the patient. |
| Where | |
|---|---|
| University Of Michigan Hospital Ann Arbor, Michigan (NRC Region 3) | |
| License number: | 21-00215-04 |
| Organization: | University Of Michigan Hospital |
| Reporting | |
| 10 CFR 35.3045(a)(1) | |
| Time - Person (Reporting Time:+19.7 h0.821 days <br />0.117 weeks <br />0.027 months <br />) | |
| Opened: | Mark Driscoll 16:42 Oct 15, 2009 |
| NRC Officer: | Joe O'Hara |
| Last Updated: | Oct 15, 2009 |
| 45436 - NRC Website | |
University Of Michigan Hospital with 10 CFR 35.3045(a)(1) | |
WEEKMONTHYEARENS 536952018-10-25T04:00:00025 October 2018 04:00:00
[Table view]10 CFR 35.3045(a)(1) Medical Event - Underdose ENS 479462012-05-17T12:00:00017 May 2012 12:00:00 10 CFR 35.3045(a)(1) Medical Event - Patient Injected with Wrong Radiopharmaceutical and Quantity ENS 466652011-03-09T15:00:0009 March 2011 15:00:00 10 CFR 35.3045(a)(1) Medical Event Involving Administration of Greater than Ordered Dose ENS 454362009-10-14T21:00:00014 October 2009 21:00:00 10 CFR 35.3045(a)(1) Patient Received Approximately 76% of the Prescribed Dose 2018-10-25T04:00:00 | |