ENS Event | |
|---|---|
05:00 Sep 28, 2022 | |
| Title | Medical Misadminstration |
| Event Description | The following summary was received from the Minnesota Department of Health via email:
A patient undergoing Lu-177 therapy was administered 110 mCi vice the prescribed 200 mCi. An investigation is in progress by the Minnesota Department of Health. 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. Minnesota Event ID: MN220005
The following information was received via email: The event date for this event was 09/28/2022. This event was discovered while investigating the event that occurred on 09/27/2022." [That event is recorded as EN56137.] Notified R3DO (Kunowski) and NMSS Events Notification email group. |
| Where | |
|---|---|
| Mayo Clinic Rochester, Minnesota (NRC Region 3) | |
| License number: | 1047 |
| Organization: | Minnesota Department Of Health |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+297.3 h12.388 days <br />1.77 weeks <br />0.407 months <br />) | |
| Opened: | Tyler Kruse 14:18 Oct 10, 2022 |
| NRC Officer: | Brian Lin |
| Last Updated: | Oct 19, 2022 |
| 56156 - NRC Website | |
Mayo Clinic with Agreement State | |
WEEKMONTHYEARENS 566712023-08-09T04:00:0009 August 2023 04:00:00
[Table view]Agreement State Lost Shipment ENS 563332022-12-16T06:00:00016 December 2022 06:00:00 Agreement State Lost Source ENS 561562022-09-28T05:00:00028 September 2022 05:00:00 Agreement State Medical Misadminstration ENS 561372022-09-27T05:00:00027 September 2022 05:00:00 Agreement State Patient Underdose ENS 560102022-07-21T05:00:00021 July 2022 05:00:00 Agreement State Medical Event ENS 553892021-07-29T05:00:00029 July 2021 05:00:00 Agreement State Ageement State Report - Medical Event ENS 552672021-05-18T05:00:00018 May 2021 05:00:00 Agreement State Patient Underdose ENS 556552020-03-17T06:00:00017 March 2020 06:00:00 Agreement State Lost Brachytherapy Seed ENS 533382018-04-13T04:00:00013 April 2018 04:00:00 Agreement State Florida Agreement State Report - Patient Received 65 Percent of Prescribed Dose to Intended Treatment Site ENS 528782017-07-28T04:00:00028 July 2017 04:00:00 Agreement State Agreement State Report - Dose Received Exceeded Prescribed Dose ENS 510252015-04-29T05:00:00029 April 2015 05:00:00 Agreement State Agreement State Report - Medical Underdose ENS 464122010-11-10T17:00:00010 November 2010 17:00:00 Agreement State Agreement State Report - Underdosage to Intended Treatment Area ENS 457882010-03-23T05:00:00023 March 2010 05:00:00 Agreement State Agreement State Report - Improper Dosage Given During Medical Treatment ENS 449492009-03-31T04:00:00031 March 2009 04:00:00 Agreement State Agreement State Report - Lost I-125 Seed 2023-08-09T04:00:00 | |