ENS 53224

v t e ENS Event
17:00 Feb 20, 2018
Title	Dose to Patient Less than the Intended Dose
Event Description	A patient was administered the radiopharmaceutical Xofigo which contains Radium Dichloride (Ra-223 CL2). The dosage is based on patient weight. The patient was administered 119.1 microCi. The patient was then weighed and found to weigh greater than 25 percent more than the weight used to calculate the dosage. This was the fourth treatment session of six prescribed. The referring physician's intended dose would have been 159 microCi, based on the patient's actual weight. This misadministration is being characterized as a personnel error. The patient and the physician have been notified and treatment will continue. 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. * * RETRACTION ON 02/22/2018 AT 1541EST FROM TRISTON DOUGALL TO STEVEN VITTO * * * The Licensee determined that the written directive was followed and therefore this event does not qualify as a misadministration. Notified R3DO(Peterson) and NMSS Events Notification email.

ENS 53224 +/- *RETRACTED*
Where
Saint Mary'S Health Care Grand Rapids, Michigan (NRC Region 3)
License number:	21-01078-01
Organization:	Saint Mary'S Health Care
Reporting

10 CFR 35.3045(a)(1)
Time - Person (Reporting Time:+22.55 h0.94 days <br />0.134 weeks <br />0.0309 months <br />)
Opened:	Triston Dougall 15:33 Feb 21, 2018
NRC Officer:	Ossy Font
Last Updated:	Feb 22, 2018
53224 - NRC Website
v • d • e

v t e Emergency Notification System
Saint Mary'S Health Care with 10 CFR 35.3045(a)(1)
WEEKMONTHYEAR2018-02-20T17:00:00 [Table view]
[ENS list for Saint Mary'S Health Care]

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