ENS 54835

v t e ENS Event
04:00 Aug 11, 2020
Title	Agreement State Report - Patient Underdose
Event Description	The [Pennsylvania] Department [of Environmental Protection (DEP)] received notification from a licensee on August 12, 2020, of a medical event involving Yttrium-90 Sir-Spheres. The licensee believes a patient received only 47% of the prescribed dose. The prescribed dose was 1.44 GBq and the delivered dose is believed to be 0.67 GBq. Preliminary cause is believed to be a clotted catheter. The licensee continues to investigate the event. The patient and referring physician were informed following the procedure. The DEP is currently in contact with the licensee and will update this event as soon as more information is provided. PA NMED Event # PA2000016 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.

ENS 54835 +/-
Where
Pa Bureau Of Radiation Protection Bethlehem, Pennsylvania (NRC Region 1)
License number:	PA-0073
Organization:	Pa Bureau Of Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+58.78 h2.449 days <br />0.35 weeks <br />0.0805 months <br />)
Opened:	John Chippo 14:47 Aug 13, 2020
NRC Officer:	Bethany Cecere
Last Updated:	Aug 13, 2020
54835 - NRC Website
v • d • e

v t e Emergency Notification System
Pennsylvania Bureau of Radiation Protection with Agreement State
WEEKMONTHYEAR	Agreement State Report - Recovered Miscellaneous Radioactive Items	Agreement State Report - Stuck Shutter 2020-09-28T04:00:00 [Table view]
[ENS list for Pennsylvania Bureau of Radiation Protection]

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