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Event Notification Report for December 20, 2019

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
12/19/2019 - 12/20/2019

** EVENT NUMBERS **


54429 54439

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Agreement State Event Number: 54429
Rep Org: NE DIV OF RADIOACTIVE MATERIALS
Licensee: DR. MICHAEL MEYER
Region: 4
City: OMAHA   State: NE
County:
License #: GL-0791
Agreement: Y
Docket:
NRC Notified By: DEB WILSON
HQ OPS Officer: ANDREW WAUGH
Notification Date: 12/09/2019
Notification Time: 16:45 [ET]
Event Date: 05/15/2019
Event Time: 00:00 [CST]
Last Update Date: 12/19/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JEREMY GROOM (R4DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)
This material event contains a "Less than Cat 3" level of radioactive material.

Event Text



EN Revision Imported Date : 12/20/2019

EN Revision Text: AGREEMENT STATE REPORT - LOST TRITIUM EXIT SIGN

This is a summary of information received from the state of Nebraska via a phone call:

On November 20, 2019, the state of Nebraska identified a lost tritium exit sign during their quarterly reports. The general licensee indicated that they improperly disposed of the exit sign by donating it to a second-hand store on May 15, 2019. The exit sign has not been located at this time. The second-hand store turns over their inventory every six months, so it is believed that the exit sign has been sold or disposed of.

The tritium exit sign is a Betalux model BX-20-BK (S/N: C167432) with an activity of 17.51 Ci.

No further investigation is planned at this time and Nebraska has closed the event.

Nebraska incident number: NE190005

* * * UPDATE ON 12/19/2019 AT 1217 EST FROM DEB WILSON TO BRIAN LIN * * *

The following was received from the state of Nebraska via email:

"On 11/20/2019, Dr. Michael Meyer, M.D. left a message reporting the loss of an exit sign that contained 17.51 Curies of Tritium, indicating he had donated the sign to Goodwill at 156th Street and Maple Road in Omaha approximately May 15, 2019. On 11/21/2019, the department [Nebraska Division of Public Health] spoke with the manager of the donation site who was unable to locate the sign. On 11/22/2019 the department spoke with Dr. Meyer again to see if he had obtained a receipt for his donation as he could not remember the exact date it was disposed of. He claimed it was put in a box with some clothes and taken to the drop-off site. Dr. Meyer did not obtain a receipt and Goodwill does not keep copies of donation receipts. The department then spoke with Goodwill's Director of Operations on 11/25/2019. The Director stated that all donations are processed within 24 hours of receipt and Goodwill does not have inventory tracking detailed enough to be able to tell if/when it was sold. Inventory is turned over every six months and after the six month period unsold items are taken to the landfill. There will be no further follow-up."

Notified R4DO (Josey) and NMSS Events (email).

THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

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Agreement State Event Number: 54439
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: SOUTHERN BAPTIST HOSPITAL OF FLORIDA
Region: 1
City: JACKSONVILLE   State: FL
County:
License #: 0155-4
Agreement: Y
Docket:
NRC Notified By: RENO J FABII
HQ OPS Officer: OSSY FONT
Notification Date: 12/12/2019
Notification Time: 12:26 [ET]
Event Date: 12/12/2019
Event Time: 00:00 [EST]
Last Update Date: 12/12/2019
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHRISTOPHER LALLY (R1DO)
NMSS_EVENTS_NOTIFICATION (EMAIL)

Event Text

AGREEMENT STATE REPORT - DOSE DELIVERED LESS THAN PRESCRIBED

The following was received from the Florida Bureau of Radiation Control (the Bureau) via email:

"[The licensee] reported that during a prostate treatment using 50 I-125 seeds, 20 of the seeds became stuck in the applicator and only 30 were inserted into the patient. All of the seeds were accounted for and the patient did not receive any additional exposure or suffer any harm. The remaining treatment dose will be fractionated and delivered at a later time. An additional detailed report containing make, model of seeds, activity, etc. will be forwarded to the Bureau's office later this week."

Incident Number: FL19-146

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.


Page Last Reviewed/Updated Friday, December 20, 2019
Friday, December 20, 2019