ML20138D054
| ML20138D054 | |
| Person / Time | |
|---|---|
| Site: | 07003042 |
| Issue date: | 03/21/1997 |
| From: | Michelle Beardsley NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| References | |
| 124360, NUDOCS 9705010014 | |
| Download: ML20138D054 (7) | |
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NR FORM 374 A U.
UCLEAR REGULATORY, COMMISSION PAGE 1 OF l PAGES g
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License b t
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SNM-1969 W
MATERIALS LICENSE Docket or Refefence Number g
g SUPPLEMENTARY SHEET 070-03042 g,
j OfflCIALRECORD00PY Amendment No. 09 q
y V. A. Medical Center in Brooklyn s
g 800 Poly Place g
g; Brooklyn, New York 11209 p
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In accordance with the letter dated March 4,1997, License Number SNM-1969 is hereby l
terminated.
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for the U.S. Nuclear Regulatory Commission E
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[g 2 l lgg7 Original Signed By:
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Date By M'chelle Boardsley gi 0 0049
$$'1H teriars safety Branch I
King of Prussia, Pennsylvania 19406 y
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9705010014 970321 14 l 1 0 R
PDR ADOCK 07003042
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l MAR 2 l 1997 i
Michael A. Sabo Medical Center Director i
V.A. Medical Center l
800 Poly Place j
Brooklyn, NY 11209 i
Dear Mr. Sabo:
Please find enclosed Amendment No. 09 terminating License No. SNM-1969 as requested by your letter dated March 4,1997.
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Your cooperation with us is appreciated.
i Sincerely, Original Signed By:
l Micholle Beardsley 1
i Michelle R. Beardsley j
Division of Nuclear Materials Safety License No. SNM-1969 Docket No. 070-03042 i
Control No. 124360 j
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Enclosure:
I-Amendment No. 09 cc:
Francis K. Herbig Health Physics Programs (115HP)
Department of Veterans Affairs 915 North Grand Blvd.
St. Louis, MO 63106 t
OFFICIAL RECC*.D COPY
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2-DOCUMENT NAME: R:\\WPS\\MLTR\\TSNM1969 To receive a copy of this document, Indicato in the box: "C' = Copy w/o attach /enci
- E" = Copy w/ attach /enci "N' = No copy OFFICE DNMS/RI a
N DNMS/RI l
NAME Beardsley JWH DATE 03/12/97 ( ' *~'
03/ /97 03/ /97 03/ /97 OFFICIAL RECORD COPY
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DEPARTMENT OF VETERANS AFFAIRS Medical Center i
J 800 Poly Place Brooklyn NY 11209 MAR 4 t997 u,
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U.S Nuclear Regulatory Commission i
Region 1 475 Allendale Road King of Prussia, Pennsylvania 19406-1415 Thru: Deputy Director, Health Physics
Subject:
License No. SNM-1969 Docket NO.
070-03042 i
1.
This is to inform you that the patient implanted with the Plutonium pacemaker passed away on Tuesday February 11,1997. The pacemaker has been retrieved and sent to Medtronic, Inc. See attached for the Radiation Safety Officer's report, We are also requesting the termination of the above license.
2.
If you require further information please contact the Radiation Safety Officer, Esfandiar Sarfaraz, Ph.D at (718) 836-6600, Ext. 6285
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oo Michael A. Sabo Medical Center Director Attachment 124360 0FFICIAi.RECORDCOPY ML10 i%R I O 1997
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Plutonium Pacemaker 4
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j Esfandiar Sarfaraz, Ph.D.
l Radiation Safety Officer (RSO)
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Date: 2/24/97 l
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The patient implanted with the Plutonium pacemaker passed away in his home at 10 pm on Tuesday, February 11,1997. The Radiation Safety Office was notified at 1:21 pm on l
Wednesday February 12,1997. Mr. Steven Courtamach, NRC Health Physicist, was notified at approximately 1:15 pm on February 13,1997. The pacemaker was retrieved
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by the director of Grant Funeral Home in Brentwood, Long Island. According to the '
patient's physician the cause of death was not pacemaker malfunction, j
The Model number and the serial number of the pacemaker were 9000 and 3R00075 respectively. The pacemaker was placed inside of the package which had been sent to j
the RSO by Medtronic,Inc. The shipping papers were provided in accordance with the manufacturer's instructions. The radiation and contamination levels of the packrge were measured prior to the shipment, and they were at background level. Medtionic, l
Inc. received the pacemaker on Monday February 24,1997.
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DEPARTMENT OF VETERANS AFFAIRS Medical Center 4
i St Louis MO 63125 j
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, March 6,1997 U.S. Nuclear Regulatory Commission 4
j Region I j
475 Allendale Rd.
King of Prussia, PA 19406-1415 i
SUBJECT:
NRC License No. SNM-1969 i
The enclosed correspondence from the Brooklyn, New York VA Medical Center has been received and is forwarded to your office for processing. If there are questions, please contact the j
facility.
I Please provide a copy of any correspondence relative to licensing actions for this Medical Center r
to:
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Department of Veterans Affairs i
Health Physics Programs (115HP) 915 North Grand Blvd.
l St. Louis, MO 63106 Sincerely, 0J/71Il/,
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Francis K. Herbig Health Physics Programs 9
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(FOR LF H S tl S E )
INFORMATION FROM LTS 3ETWEEN:
LICENS E FEE M AN ASEMENT BRANCM, ARM PROGRAM CODE: 22160 AND STATUS CODE: 0 4
REGION AL LIC ENSING SECTION S FEE CATEGORY: EX 7C EXP. DATE: 20010630 FEE COMMENTS: PACEMAKER /REF 31-0289 DECOM FIN ASSUR REQD: N t
LICENSE FEE TRANSMITTAL A.
REGION 4
1.
APPLIC ATION ATT ACHED A PPLIC ANT / L ICE N S EE:
V.
A.
ME DIr " C ENT E R R ECEIVED D ATE:
970310 00CKET NO:
7003042 CONTROL NO.:
124360 LICENFE NO.:
SNM-1959 ACTION TYPE:
T ERMIN ATION 2.
FEE ATTACHED AMOUNT:
CHECK NO.:
- 3. COMMENTS SIGNED ^~ ~ ~~(/ ~-
1V/2Zfl~:~~~_~~_~_
oATE B.
LICENSE "EE 74ANAGEMENT BRANCH (CHECK WMEN MILESTONE 03 IS ENTERED /__/)
1.
FEE CATEGORY AND AMOUNT:
2.
CORRECT FEE PAIO.
APPLIC ATION M AY BE PROCESSED FORA AMENDMENT RENEWAL LICENSE 3.
OTHER SIGNED DATE
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