ML20212G208
| ML20212G208 | |
| Person / Time | |
|---|---|
| Site: | 07002232 |
| Issue date: | 10/02/1997 |
| From: | Tara Weidner NRC OFFICE OF INSPECTION & ENFORCEMENT (IE REGION I) |
| To: | |
| Shared Package | |
| ML19313D046 | List: |
| References | |
| 124891, NUDOCS 9711060085 | |
| Download: ML20212G208 (11) | |
Text
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U LEAR RE!ULATORY COMMISSION [] PAGE 1 OF l PAGES l l g
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SNM-1646 g l l , MATERIALS LICENSE Docket or Refetence Numtw g l p SUPPLEMENTARY SHEET 070-02232 g I Amendment No. 04 l'
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lMt.Ephraim&AtlanticAvenue's Camden, New Jersey 08104 l, I I I I N in accorG; ce witn the letter dated September 19, 1997, License Number SNM-1646 is hereby !
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N terminated.
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For the U.S. Nuclear Regulatory Commission N
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ORIGINAL' SIGNED BY:
cate By TARA L.WEIDNER Nuclear Materials Safety Branch Region I King of Prussia, Pennsylvania 19406 m 'ML10D5 l 7711060085 971002 '
PDR ADOCK 07002232 m_____ C _ _ _ _ _ _ __ _ _ _ __ _ _ P_DR_ _ _ _ _ _ _ _ _ _ _ _ sust a m m m m m m m m m m m m m m m m m m m m m m m u
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O O OCT - 21997 Kevin Manley Vice Presi-lent of Hospital Affairs West Jersey Hospital Mt. Ephraim & Atlantic Avenues Camden, NJ 08104
Dear Mr. Manley:
Please find enclosed Amendment No. 04 terminating License No. SNM 1646 as j requested by your letter dated September 19,1997.
Your cooperation with us is appreciated.
Sincere!y, ORIGINAL SIGNED BY:
TARA Le WEIDNER Tara L. Weidner Division of Nuclear Materials Safety License No. SNM-1646 Docket No. 070-02232 Control No. 124891 Enciosure:
Amendment No. 04 DOCUMENT NAME: R:\WPS\MLTR\LSNM1646 To receive a copy of inis document, bc ete in the box: 'C' = Copy w/o attach /enci "E* = Copy w/ attach /enci "N* = No copy OFFICE DNMS/RI g lN DNMS/RI NAME Weidner/W DATE 10/01/97 10/ /97 10/ /97 10/ /97 OFFICIAL RECORD COPY M!.10
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WFSI' JERSEY f7 IIEAl!!'liSWl'EM September 19,1997 SL 010 Tara Weidner llealth Physicist US Regulatory Commission Region 1,475 Allendale road King of Prussia, A 19406 1415 RE: License No, SNM 1646 Dear Ms. Weidner; The last two nuclear pacemakers have been removed from our active pacemaker list.
Mot! # Cordis 184A serial # 00413 was explanted from Terry Fallstick at West Jersey IIealth System, Voorhees, NJ on June 1 1997 and retumed to Mr. Jeffrey liill of Accufix Research Institute. Enclosed is copy of the letter confirming that Accufix received the pacemaker.
Model C-101 Serial 169 was explanted from( at Our Lady of Lourdes Hospital in Camden, NJ on June 18, 1997 and retumed to Mr. Joseph Klingensmith of Biocontrol Technologies, Inc. Enclosed is copy of the letter confinning that Biocontrol received the pacemaker.
Please terminate West Jersey IIealth Systems' pacemaker license.
Thank you.
Sincerely, M asep M
- Centrone, M.D.
ladiation Safety Officer
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$~ l Kevi Manley /2 ffi/
Vice President ofllospital Affairs.- M' L 10 naw,*va co..u,,uru ,aw- s,*"' 0FFicW.RECORDCOPY SEP 2 5 1997 West Jersey liesith System West Jerwy thnpttalCamden west Jersey llospitdBerhn W est Jeney llospital Voorhees t est Jerwy llospadMarlton Corporate Offices 1000 Atlantk Avenue White llorw Pike & 101 Carrue Boukvard Rt. 73 & Brick Road Camden, NJ 08104 Townsend Avenue Voorhees, NJ 0H013 Marlton, NJ 08053 1000 Atlantk Avenue Camden, NJ 08 tel (609) 3424000 Berhn, NJ 08009 (609) 772 $000 (409) 596 3500 (609) 342 4000 (609) 768 6000 i
0 O BLOCONTROL veemmess4w see, July 23,1997 Re: Isotopic Material Trentrer Confirmation To Whom It May Concern:
This letter confinn: that on July 1,1997, Illocontrol received the IsrJapic source listed below '
from the Shipped Prom address listed below. This source is now in the possession of13tocontral Technology, Inc.
Irnplanting Insdtution Transf' erred To:
- Transferred Froent License
- SNM 1319 License No.: SNM-1646 Blocontrol Technology, Inc.
l' hone No.: 609 *'95,3000 300 Indian Springs Road
[ Address: West Jersey Hospital Indiana, PA 15701 Emstem Division atta. Joseph Klingenomith, RSO Voorhees, NJ 08043 112 349 1811
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Explanting IAUitution Shipped To: l Shipped From: (same as Transferred To)
Our Lady of Lourdes liospital le 'lladden Avenue C. . '.4en, NJ 08103 Isotopic Sour-e Transf' erred Pacemaker Model No.:C-101 Pacemaker SerialNo.: 169
' Source No.: X 68 Patient: I v
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If you have any questions, pleau contact me.
Sincer.ly, dkW deu Joseph N. Klingensmith RSO cc: Transferred Prom Ehlpped From Patient / Pacemaker Record 09/19/97 07:20 TX/ItX NO 0150 P 002 g
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July 30, i,97 ACCUFIX RESEARCH i IN S TIT U T E t
West Jersey lieshh Systems Carate Blwl Atm: Lillian Torill Radiation Dept.
Voorhees.NJ 08043 4 l
Dear Ms. Tert 11:
This ler+v is to inform you we have receivt d the Omnl4tanicer 184 A/413, explanted from Tir device was received in mm Miami Lakes offke on 7/9/97, if you have Aarther or lease call me at 303445 8053.
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S p ely, ,j, 79 M-4.t Jemey Hdi Prodou Performance 4
7301 South Reven Parkway e Englewood, Colorado 80112 Phone: (303) 754@51
- Facstintle: (303) 645-8080 09/19/97 07:29 TX/RX NO.6150 P.001
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TELEPHONE CONVERSATON RECORD Date: 8 14-97 Time: 11:00 Mail Control No.: 124891 License No.: Docket No.:
SNM-1646 070 02232 Person Called: Lillian Terrill Licensee: West Telephone Jersey Hospital Number:
609-772 5010 1
Person Calling: Tara Weidner 337-5272
Subject:
License termination Summary: The letter that requests termination of the pacemaker license needs to be signed by management.
ActionRequirdf/Taken: Aait for! info SignaturaM/ /fg/ Date: p /f <
m 0FFICIAl.RE00RD00PY ML 10
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O O This is to acknowledge the receipt of your letter / application dated 7 , and to inf orm you that the initial processing which includes an administrative review has been performed, y.gg, ggg SH There were no administrative omissions. Your application was assigned to a techn6 cal reviewer. Iicase note that the technical review may identify additional omissions os reyuire additionalinformation.
O ,, ease orovide to this office within 30 da<s of your receipt of thi. card A copy of your action has been forwarded to our License Fee & Accounts Receivable Branch, who w,'l contact you separately if there is a fee issue involved.
Your action has been assigned Mail Control Number l2d391 When calling to inquire about this action, please refer to this control number.
You may call us on (610) 337 5398, or 337 5260.
esc rew or m Sincerely, n em Licensing Assistance Team Leader
o o WEST JERSEY HEALTH SYSTEM Friday August 8,1997 Michelle Beardsley Health Physicist o70 ' o@9 3 l U.S. Regulatory Commission l Region 1 475 Allendale Road King of Prussia, Pa. 19406-1415 1
RE: License # SNM 1846 l
Dear Ms. Beardsley,
We have remov68 'he last two nuclear pacemakers from our active pacemaker list. One of the pacemakers was model # oordis 184 A Serial # 00413.
Due to intermittent lack of capture it was explanted at our facility on July 2,1997.
This pacemaker was sent to Mr. Jeff Hill at Accufix Rssearch Institue. Enclosed is a copy of the letter we received from Accutix. The other pacemaker was explanted Our Lady of Lourdes Hospital Camden N.J. on June 18,1997. The model # is C - 101 Serial # 169, it was sent to Biocon'Jol Technology Inc. to Mr. Joseph Klingensmith. Enclosed is a copy of the letter we received from them. Since there are no more pacemakers active under West Jersey Hospital License we would like to terminate our pacemaker license.
Thank you.
Sincerely,
&- fwd M. i Lillian Terrill R.T. 801 ChiefTechnologist 0FFICIAl.RECORDCOPY ML10 AUG l 31997
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I July 30,1997 iR ACCUFIX RESEARCH IN STITUT E West Jersey ILatth Systems e Carnie Blvd.
Attn: Lillian Terill Radiation Dept.
Voorhecs, NJ 08043
Dear Ms. Terill:
'Ihis letter is to inform you we have received the Ornni Stanicor 184A/413, explanted from patient [
]'Ihe device was received in our Miami Lakes omcc on 7/9/97. If you have further questions or concenis, please call me at 303-645 8053.
gecrely, yx4t'.<u, jeffrey flill Product Perfonnance
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- J-l 7307 South lievere l'arkway
- Englewood, Colorado 80112 I rmnno mom 7 s t.omi . vncsimil. - (: urn r>tr, soso
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July 23,1997 Re:. Isotopic hiaterial Transfer Confirmation To Whom It hiay Concern:
This letter confimis that on July 1,1997, Biocontrol received the isotopic source listed below from the Shipped Frorn address listed below. This source is now in the possession of Biocontrol Tecimology, Inc.
Implanting lustitution Transferred To:
Transferred Fronu License: SNht-1319 License No.: SNM-1646 Blocontrol Technology,Inc.
Phone No.: 609-795-3000 300 Indian Springs Road Address: West Jersey llospital Indiana, PA 15701 Eastern Division attn. Joseph Klingensmith, RSO Voorhees, NJ 08043 412-349 1811 Explanting Institution Shipped To:
Shipped From: (same as Transferred To)
Our Lady of Lourdes Hospital 1600lladden Avenue Camden, NJ 08103 Isotopic Source Transferred Pacemaker hiodel No.:C-101 Pacemaker Serial No.: 169 Source No.: X 68 Patient: I
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Ifyou have any questions, please contact me.
Sincerely, lk $k <M Joseph N. Klingensmith RSO cc: Transferred From Shipped From Patient / Pacemaker Record +-
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