Event Notification Report for June 21, 2004
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
06/20/2004 - 06/21/2004
Hospital
Event Number: 40834
Rep Org: POTOMAC HOSPITAL
Licensee: POTOMAC HOSPITAL
Region: 1
City: WOODBRIDGE State: VA
County:
License #: 45-15367-01
Agreement: N
Docket:
NRC Notified By: ROBERT YANCE
HQ OPS Officer: JEFF HIXON
Licensee: POTOMAC HOSPITAL
Region: 1
City: WOODBRIDGE State: VA
County:
License #: 45-15367-01
Agreement: N
Docket:
NRC Notified By: ROBERT YANCE
HQ OPS Officer: JEFF HIXON
Notification Date: 06/22/2004
Notification Time: 16:49 [ET]
Event Date: 06/21/2004
Event Time: 12:15 [EDT]
Last Update Date: 06/22/2004
Notification Time: 16:49 [ET]
Event Date: 06/21/2004
Event Time: 12:15 [EDT]
Last Update Date: 06/22/2004
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(2) - DOSE > SPECIFIED EFF LIMITS
10 CFR Section:
35.3045(a)(2) - DOSE > SPECIFIED EFF LIMITS
Person (Organization):
ANTHONY DIMITRIADIS (R1)
M. WAYNE HODGES (NMSS)
ANTHONY DIMITRIADIS (R1)
M. WAYNE HODGES (NMSS)
MEDICAL EVENT
Thallous Chloride (4 mCi of Tl-201) was injected into a patient without a prescription. A technician asked the patient before administering the dose if he/she was the person on the prescription. The patient responded positively. The technician administered the dose to the patient without checking the patient's wrist-band identification to confirm the patient's identity. The Thallous Chloride was prescribed to a different patient in preparation for an X-ray examination of the heart.
The physician notified the patient that he/she inadvertently received a 4 mCi dose of Thallous Chloride. The physician determined that no medical treatment was required to treat the effects of the misadministered dose. The technician has received counseling, a copy of the hospital's identification policy, and a written warning as a corrective measures action.
Thallous Chloride (4 mCi of Tl-201) was injected into a patient without a prescription. A technician asked the patient before administering the dose if he/she was the person on the prescription. The patient responded positively. The technician administered the dose to the patient without checking the patient's wrist-band identification to confirm the patient's identity. The Thallous Chloride was prescribed to a different patient in preparation for an X-ray examination of the heart.
The physician notified the patient that he/she inadvertently received a 4 mCi dose of Thallous Chloride. The physician determined that no medical treatment was required to treat the effects of the misadministered dose. The technician has received counseling, a copy of the hospital's identification policy, and a written warning as a corrective measures action.
General Information or Other
Event Number: 40831
Rep Org: MISSISSIPPI DIV OF RAD HEALTH
Licensee: GALLET ASSOC.
Region: 1
City: FLOWOOD State: MS
County:
License #: AL991
Agreement: Y
Docket:
NRC Notified By: B. J. SMITH
HQ OPS Officer: JOHN MacKINNON
Licensee: GALLET ASSOC.
Region: 1
City: FLOWOOD State: MS
County:
License #: AL991
Agreement: Y
Docket:
NRC Notified By: B. J. SMITH
HQ OPS Officer: JOHN MacKINNON
Notification Date: 06/22/2004
Notification Time: 10:58 [ET]
Event Date: 06/21/2004
Event Time: 18:00 [CDT]
Last Update Date: 07/08/2004
Notification Time: 10:58 [ET]
Event Date: 06/21/2004
Event Time: 18:00 [CDT]
Last Update Date: 07/08/2004
Emergency Class: NON EMERGENCY
10 CFR Section:
10 CFR Section:
Person (Organization):
ANTHONY DIMITRIADIS (R1)
LlINDA PSYK-GERSEY (NMSS)
ANTHONY DIMITRIADIS (R1)
LlINDA PSYK-GERSEY (NMSS)
MISSISSIPPI AGREEMENT STATE REPORT: TROXLER GAUGE RUN OVER BY A BULLDOZER.
On 06/21/04 at 1800 CDT an Alabama licensee, Gallet Associates, had one of their Troxler gauges; Model # 3401, gauge serial number 12283; run over by a bulldozer in Flowood, Mississippi. The rod was broken off. Surveys taken of the rod was 10 mRem/hr at one foot. The gauge has been stored and the licensee will call Troxler. The gauge contained 8.6 milliCuries of Cesium-137 and 40 milliCuries of Am-241/Be.
State of Mississippi assigned event for this incident is MS-04-005
* * * UPDATE VIA EMAIL FROM B. SMITH TO JEFF ROTTON AT 1205 EDT ON 07/08/04 * * *
"Damaged gauge and Cesium-137 source picked up by AEA Technology (QSA) from Mississippi Division of Radiological Health office for transport back to AEA facility located in Baton Rouge, LA. AEA will handle disposal of sources."
Notified R1DO (Holody) and NMSS EO (Essig).
On 06/21/04 at 1800 CDT an Alabama licensee, Gallet Associates, had one of their Troxler gauges; Model # 3401, gauge serial number 12283; run over by a bulldozer in Flowood, Mississippi. The rod was broken off. Surveys taken of the rod was 10 mRem/hr at one foot. The gauge has been stored and the licensee will call Troxler. The gauge contained 8.6 milliCuries of Cesium-137 and 40 milliCuries of Am-241/Be.
State of Mississippi assigned event for this incident is MS-04-005
* * * UPDATE VIA EMAIL FROM B. SMITH TO JEFF ROTTON AT 1205 EDT ON 07/08/04 * * *
"Damaged gauge and Cesium-137 source picked up by AEA Technology (QSA) from Mississippi Division of Radiological Health office for transport back to AEA facility located in Baton Rouge, LA. AEA will handle disposal of sources."
Notified R1DO (Holody) and NMSS EO (Essig).