ENS 41719
ENS Event | |
|---|---|
07:00 Mar 21, 2005 | |
| Title | Agreement State Report - Lost 12 Unused I-125 Therapy Seeds Totaling 4.8 Millicuries |
| Event Description | The State provided the following information via facsimile:
On March 21, 2005, the licensee, Western Medical Center, shipped 12 unused I-125 therapy seeds of 0.4 mCi/seed (4.8 mCi total) to GE Healthcare via Fed-Ex. On April 19, 2005, Fed-Ex notified the licensee by letter that the shipment had apparently been lost in transit. The shipment has not yet been located. [The State] will update NMED as more information becomes available. The Fed Ex shipment information will be forthcoming from the State as they receive it. The State report number is 051905.
The number of seeds should be 14 at 0.391 mCi/seed for a total of 5.474 mCi (as of 2/26/05; activity is now about 2.12 mCi). The shipment left the licensee's facility on 3/21/05 via FedEx to GE Healthcare in Arlington, IL. On 3/24/05, the licensee was first notified by GE Healthcare that they had received the package, but that it did not contain the seeds, but some type of brackets. The licensee notified FedEx, who initiated a tracking operation. On 4/19/05, the licensee received written notice from FedEx that the package still had not been found. The records internal to FedEx indicated the package had apparently been damaged during the shipment, and FedEx speculates the shipping papers were switched with the other shipment. [The State] will provide additional information at the close of the investigation into this matter. Notifications were given to R4DO (Nease) and NMSS (Moore & Correia)
This is a follow up to the reported lost shipment of I-125 seeds, which are now found. The seeds were delivered to the shippee, GE Healthcare, on March 24, 2005. The contact from GE Healthcare to the licensee in California indicated they had received an unexpected package from them (containing some type of brackets), but was not intended to indicate they had not received the package containing the seeds. The California licensee interpreted the information from GE Healthcare to mean that the seeds they had shipped had not arrived, however this apparently was not the case. Receipts of non-radioactive and radioactive shipments are handled separately at GE Healthcare, so the call to the California licensee was only to report the receipt of the unexpected non-radioactive shipment. Thus, GE Healthcare received the seeds on March 24, 2005, and knew they had received them on that date. There was simply a misunderstanding in the communication with the California licensee. Notifications were given to R4DO (Nease) and NMSS (Correia) |
| Where | |
|---|---|
| Western Medical Center Santa Ana, California (NRC Region 4) | |
| License number: | 0231-30 |
| Organization: | California Radiation Control Prgm |
| Reporting | |
| Agreement State | |
| Time - Person (Reporting Time:+1423.7 h59.321 days <br />8.474 weeks <br />1.95 months <br />) | |
| Opened: | Barbara Hamrick 13:42 May 19, 2005 |
| NRC Officer: | John Knoke |
| Last Updated: | May 20, 2005 |
| 41719 - NRC Website | |
Western Medical Center with Agreement State | |
WEEKMONTHYEARENS 417192005-03-21T07:00:00021 March 2005 07:00:00
[Table view]Agreement State Agreement State Report - Lost 12 Unused I-125 Therapy Seeds Totaling 4.8 Millicuries 2005-03-21T07:00:00 | |