ENS Event | |
|---|---|
07:00 Jun 12, 2020 | |
| Title | Agreement State Report - Medical Event |
| Event Description | The following was received from the Arizona Department of Health Services (the Department) via email:
On June 12, 2020, the Department received notification from the licensee of a possible medical event involving an I-125 eye plaque. A patient was implanted with an eye plaque on June 4, with a prescribed dose of 85 Gy. On June 8, the patient had a stroke and was admitted to St. Joseph's Medical Center. Once the patient was able to be transported, they were transported back to the Mayo Clinic Hospital on June 9. It was then determined that the patient was not strong enough to endure the procedure for removing the eye plaque. The eye plaque was finally removed on June 11 and the final dose to the tumor was 123.5 Gy or 145.3 percent of the prescription. The Department has requested additional information and continues to investigate the event. Arizona Incident 20-010 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 | |
|---|---|
| Arizona Dept Of Health Services Phoenix, Arizona (NRC Region 4) | |
| License number: | 07-448 |
| Organization: | Arizona Dept Of Health Services |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+37.13 h1.547 days <br />0.221 weeks <br />0.0509 months <br />) | |
| Opened: | Brian Goretzki 20:08 Jun 13, 2020 |
| NRC Officer: | Jeffrey Whited |
| Last Updated: | Jun 13, 2020 |
| 54745 - NRC Website | |
Arizona Department of Health Services with Agreement State | ||
WEEKMONTHYEARENS 557722022-03-07T07:00:0007 March 2022 07:00:00 Agreement State Potentially Radioactive Material Discovered ENS 557302022-02-04T07:00:0004 February 2022 07:00:00 Agreement State Stolen Tritium Exit Signs ENS 549042020-09-16T07:00:00016 September 2020 07:00:00 Agreement State | Agreement State Report - Construction Gauge Run Over by Construction Van ENS 548432020-08-18T07:00:00018 August 2020 07:00:00 Agreement State Agreement State Report - Missing Source Rod Shutter ENS 548112020-08-03T07:00:0003 August 2020 07:00:00 Agreement State Agreement State Report - Missing Shutter on Fixed Gauge ENS 547452020-06-12T07:00:00012 June 2020 07:00:00 Agreement State Agreement State Report - Medical Event ENS 547462020-06-11T07:00:00011 June 2020 07:00:00 Agreement State Agreement State Report - Found Radioactive Material ENS 546732020-04-18T01:00:00018 April 2020 01:00:00 Agreement State Agreement State Report - Possible Medical Event ENS 545222020-02-11T07:00:00011 February 2020 07:00:00 Agreement State Agreement State Report - Lost Brachytherapy Seed ENS 545052020-01-31T07:00:00031 January 2020 07:00:00 Agreement State Agreement State Report - Moisture Density Gauge Run Over by Vehicle ENS 545012020-01-29T07:00:00029 January 2020 07:00:00 Agreement State Agreement State Report - Stolen Source ENS 544122019-11-26T07:00:00026 November 2019 07:00:00 Agreement State Agreement State Report - Possible Found Radioactive Material 2022-03-07T07:00:00 [Table view] | |