ENS Event | |
|---|---|
04:00 Jul 5, 2019 | |
| Title | Agreement State Report - Patient Underdose |
| Event Description | The follow was received via fax:
On July 8, 2019, the Department [Pennsylvania Department, Bureau of Radiation Protection] became aware of an under-dose event involving yttrium-90 (Y-90) SIR-Spheres. It is reportable as per 10 CFR 35.3045(a)(1)(i). On July 5, 2019, a patient underwent a Y-90 SIR-Sphere treatment. The total dosage of 9.58 mCi was split into two equal dosages of 4.79 mCi to be administered to segments 5 and 8 of the liver. The first vial, segment 5, was successfully administered but only 75.7 percent or 3.6 mCi of the second vial was administered to segment 8. The referring physician and the patient were verbally informed. No harm is expected to the patient. The Department will perform a reactive inspection. Event Report ID No.: PA190015 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. |
| Where | |
|---|---|
| Thomas Jefferson University Philadelphia, Pennsylvania (NRC Region 1) | |
| License number: | PA-0130 |
| Organization: | Pa Bureau Of Radiation Protection |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+81.15 h3.381 days <br />0.483 weeks <br />0.111 months <br />) | |
| Opened: | John Chippo 13:09 Jul 8, 2019 |
| NRC Officer: | Jeffrey Whited |
| Last Updated: | Jul 8, 2019 |
| 54151 - NRC Website | |
Thomas Jefferson University with Agreement State | |
WEEKMONTHYEARENS 541512019-07-05T04:00:0005 July 2019 04:00:00
[Table view]Agreement State Agreement State Report - Patient Underdose 2019-07-05T04:00:00 | |