ENS 44979

v t e ENS Event
15:45 Apr 8, 2009
Title	Agreement State Report - Misadministration Involving Y-90 Microspheres
Event Description	The following was received via facsimile: N.C. Radiation Protection Section was notified of a misadministration involving Y-90 microspheres. The licensee reports that the administered dosage was 24 percent less than the prescribed dosage. Licensee reports no equipment malfunction and no leakage of radioactive material from the delivery device. Licensee has notified patient and there are no plans to perform a second administration. Licensee is contacting vendor to assist in investigation. N.C. Radiation Protection has not received any media attention as of this report. No press release has been issued. The North Carolina Event Report ID Number for this event is NC-09-22. 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.

ENS 44979 +/-
Where
University Of North Carolina Hospitals Chapel Hill, North Carolina (NRC Region 1)
License number:	068-0565-1
Organization:	Nc Div Of Radiation Protection
Reporting

Agreement State
Time - Person (Reporting Time:+22.05 h0.919 days <br />0.131 weeks <br />0.0302 months <br />)
Opened:	Henry Barnes 13:48 Apr 9, 2009
NRC Officer:	Donald Norwood
Last Updated:	Apr 9, 2009
44979 - NRC Website
v • d • e

v t e Emergency Notification System
University Of North Carolina Hospitals with Agreement State
WEEKMONTHYEAR2009-04-08T15:45:00 [Table view]
[ENS list for University Of North Carolina Hospitals]

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