View source for PNO-IV-88-010, on 880204,therapy Misadministration of P-32 Discovered.Physician Prescribed 4.0 Mci P-32 for Treatment of Polycythemia Vera (Excess Blood Platelets).Caused by Technologist Error.No Adverse Patient Effects Expected

{{Adams
| number = ML20149E013
| issue date = 02/05/1988
| title = PNO-IV-88-010:on 880204,therapy Misadministration of P-32 Discovered.Physician Prescribed 4.0 Mci P-32 for Treatment of Polycythemia Vera (Excess Blood Platelets).Caused by Technologist Error.No Adverse Patient Effects Expected
| author name = Cain C
| author affiliation = NRC OFFICE OF INSPECTION &amp; ENFORCEMENT (IE REGION IV)
| addressee name = 
| addressee affiliation = 
| docket = 03003233
| license number = 
| contact person = 
| document report number = PNO-IV-88-010, PNO-IV-88-10, NUDOCS 8802100169
| document type = PRELIMINARY NOTIFICATION OF EVENT OR OCCURRENCE (PNO,, TEXT-INSPECTION &amp; AUDIT &amp; I&amp;E CIRCULARS
| page count = 1
}}
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February 5, 1988 PRELIMINARY NOTIFICATION OF EVENT OR UNUSUAL OCCURRENCE -- PNO-IV-88-10                       -
This preliminary notification constitutes EARLY notice of events of POSSIBLE i
safety or public interest significance.        The information is as initially received without verification or evaluation, and is basically all that is known by the Region IV staff en this date.
FACILITY: Medical X-Ray Center, P.C.                   Licensee Emergency Classification:
1417 South Minnesota Avenue                      Notification of Unusual Event Sioux Falls, South Dakota                        Alert LN 40-01493-02                                   Site Area Emergency General Emergency X    Not Applicable

==SUBJECT:==
THERAPY MISADMINISTRATION OF PHOSPHORUS-32 The licensee reported a therapy misadministration which occurred at 3:00 p.m. on February 4, 1988. The licensee representative stated that the physician prescribed 4.0 millicuries of P-32 as sodium phosphate for treatment of
         -polycythemia vera (excess blood platelets). The. technologist misread the physician's writte.; prescription and administered 7.5 millicuries. The referring physician and patient have been informed. The licensee stated that no adverse patient effects are expected.
Neither the licensee nor the NRC has issued a press release or informed the news media. Neither the licensee nor the NRC plans to issue a press release.
The state of South Dakota has been informed.
e
;         Region IV received notification of this occurrence by telephone from the j         licensee at 10:30 a.m. CST.      Region IV has informed NMSS.
CONTACT:    C. L. Cain, FTS 728-8186.
DISTRIBUTION:
MAIL:
H. St.                  MNBB         E/W           Willste        DCS (Original)
Chairman Zech           AE00         OIA           NMSS           DOT:(Trans only)
Comm. Roberts           PA           01 Comm. Bernthal          OGC          VIB                           FAX:
a Comm. Carr              MPA                                        IRPO Comm. Rogers            ARM                                        NSAC ACRS                                                               RRI SECY                                                               NRC OC CA                      Phillips         AirRights                 LICENSEE:
PDR                     NRR              SLITP                        (Reactor Licensee)
OGC-H GPA ACRS                    Nicholson Lane POR                     RES Regional Offices                                                             "
9pRIf{y;0RSS              RA                                Transmitted via 5520 2/5/88 A    RLungart:cd             RDMartin                          @11:35 a.m.
2/Q88                   2/[/88 8802100169 800205-PDR     I&E                   N PNO-IV-08-010 PDR}}

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