ML20214M487
| ML20214M487 | |
| Person / Time | |
|---|---|
| Site: | 07002199 |
| Issue date: | 07/22/1983 |
| From: | Gavazzi A VETERANS ADMIN. MEDICAL CENTER, WASHINGTON, DC |
| To: | Vacca P NRC OFFICE OF NUCLEAR MATERIAL SAFETY & SAFEGUARDS (NMSS) |
| Shared Package | |
| ML20213D562 | List: |
| References | |
| 22581, NUDOCS 8609110138 | |
| Download: ML20214M487 (3) | |
Text
'
g p7 g f)
M;dic;l Crnt:r (
50 Irving Street, NW.
v Washington D.C. 20422
=# 2252/
Veterans -
N Administration 70-2/7 7 In Reply Refer To:
July 22, 1983
.g3 $ M Ffs. Patri?'.a C. Vacca h!aterial Licensing Branch Division of Fuel Cycle and Material Safety US Nuclear Regulatory Commission Washington, D.C. 20555
Dear his. Vacca:
The enclosed report is provided as a follow-up to the " report of malfunction" submitted on June 10, 1983.
to '8.88 ut sr Q
. GAV I
(/
Ffe ical nte Director enclosure cc: Chief of Cardiology Section/ Ffedical Service RSO File l
8609110138 860829 i
REG 1 LIC70 PDR SNM-1605 hpn liiEC2 Ws3
SNM-1605 Report of Explantation of Nuclear Powered Pacemaker 1
Manufacturer: Cordis 2.
Model Number: 184A 3
Serial Number:
140 4.
Date Implanted: Jan. 19, 1977 5.
Date Malfunction was discovered: June 2,1983 6.
Date of Explantation: June 3, 1983 7.
Nature of Failure:
Failure to Sense 8
Current Status of Patient:
The patient left Washington VA against medical advice on June 2, 1983.
Ile requested and received treatment at Sacred Heart ilospital in Cumberland, Maryland. The pacemaker unit was explanted on June 3,1983 at Sacred lleart ilospital. A new conventional pacemaker was implanted.
9.
Disposition of Pacemaker:
Sacred lleart Ilospital shipped the explanted pacemaker to us at the request of our radiation safety officer. We received the unit (184A-140) on July 1, 1983. We shipped the unit to Cordis Corporation via Federal Express on July 8,1983. The unit was packaged according to Cordis' instructions and shipped in accordance with Department of Transportation regulations, t
g g
REPORT OF PACEMAKER REMOVAL /PATItaf DEATH
/
I
/ MMS-6.. d (This note should filed in the license issued t :
License No. SNM-
'.. Docket:No. 070- J /f f L, TIME AND DATE OF CALL:
IAi2Lef
!.hk!fj7
/dtetw, d
I CALLER'S NAME:
L CALLER'S INSTITUTION / ADDRESS
[ bMb, NAME OF MANUFACTURER OF PACEMAKER:
44/N MODEL NUMBER OF PACEMAKER: /M8 Serial No.: /@
/!/9!77 DATE IMPLANTED:
REASON FOR CALL:
Death of patient -- Date of Death Cause of death:
Pacemaker-related? Yes.
No N
Removed
,m tient 3h: 4[/3&/'V((8 Reason fo r al: N M W - M t44L S M R f)44.]
jtMLA.J-/k.- ffff)
~
%,, 1 -
Other--Explain:
EXPLANTED PACEMAKER IS LOCATED AT:.
4 A_. 'C 4f, bh'M na.,waaam-u m kwn -
J M f /v
/R C&dt D G.
PACEMAKER BEING RETURNED TO THE MANUFACTURER?
Yes, by I N M b e d
aam No; explain:
l CALLER REMINDED TO FILE WRITTEN REPORT WITHIN 30 DAYS? Yes 2 No WY N/2^--
Signature of NRC staff member who took call 1
8 1
1
~
-