- ‘or follow-up of @ chronic levkotente of ‘uncertain etiology.
% seen d8.a% unscheduled asmisdion:c y-2h-62, ‘complaining of @ sore
throat’ sulcure at that “time shoved - “Streptrcoceus! .)

not call me for, the report of the culttre ‘as he had been instructed, ‘and I
assumed that-he had gone to. __ \for treatment of his.sore throat. How-
ever, I learned that be had forgotten to call’ me and ¢id not see Dr. Fortney a5
nis throat scon became better. Within .a-week.hebecams entirely asymptomatic

and has pad no recurrence of sore threat. ‘The patien. has also had no recurrence
of back pain. He described himself as feeling “fine.”

Tetrerature 37, pulse 96, and respirations 18. ' Weight 131 sounds. His throat
appeared normel. There vas no hepatosplenomegaly or adenopathy. Hemoglobin 15.5...
g2 with a hematocrit of 4O%. WBC 2,350. Platelet count 240,000. Sedinentation
rate 12 mn per hour uncorrected.

Despite the significant leukupenia the patient appears to te doting quite well
clinicaliy. 4 is interesting that under the striss of infection to mouths ‘ago
there was agein # significant increase in the WRC. -... - given an appoint
ment te return ou 3-7-62 when he is 9 have a CBC, platelet ca nd benr maitow
aspiration. T instructed the patiene to contact us o> Dr. iif he €2veloped
any evidence of an infection at any time. °



ORNL RADIATION EXPOSURE RECORD For s959 4% OP2A (REV. 31.36)
SYMBOLS: HP WK . HEALTH PHYSICS WEEX; IRR — FiL IRREGULARITIES, win WINDOW; PLA — PLassic FILTER; ALU ~ AE

FILTER; CAD ~ cg FILTER; a, ~ NON-PEN. DOSE, 2, ~ MOO. PEN. DosE; Dy, ~ EYE Dose; O, — PEN. DOSE; TsR . POCKET
METER TOTAL; A — DOSE BROUGHT FoRwaro, s . TOTAL DOSE TO DATE.

4P FILM DENSITY OOSE farems)

QUARTERLY TOTALS

| Lieegd win | pia | atu | ca ie ee ee ae Oy} a TSR
ela 12 0Stidal [yal “hee eal we [Geli  —
fo 2b£ | Af $6 MENUS A UES, pon bMS) MEL EL om
WS . og . Jel sx) 5%] IST MUSH S|
Sa 2 2 Sets). 24 gs sp -
: 1S EP IEY: =
a etd eed ae a ee
LAS 1/90 9 6
ALG | eed | gov

$2: | 270 FSD)



OAK RIDGE INSTITUTE OF NUCLEAR STUDIES

7.8. Box tty

Oak RIDGE. TENNESSEE 37830

AREA cone ers
TELEPHONE anzestt

June 7, 1966

- seve ae

i am sorry to be so tardy in acknowledging your letter of
April 5. It was a surprise to learn that you are now working
in Bethesda.

I asked D- knew of a hematologist in the
Washington area, He gave ne the name of Dr, 7 i
Reservoir Blvd, Washington, ,,

1 had a letter from Dr. bn November 25, 1965. I am
sure he will be glad to send a report of your findings at the
Emory University Clinic to Dr, 4

DAW :weh

OPERATED BY OAK RIDGE ASSOCIATED UNIVERSITIES



@

Bo
57

OAK RIDGE INSTITUCE OF NUCLEAR STUDIES
MEDICAL DIVISION

PATISRT ADMITTANCE AGREEMBRT

In corsaideration of mr being eccepted and adnitted to the Reasearch
Hospital operated by the Oak Ridge Institute cf Nuclear Studies, I, on
vehalf of myself, my heirs, executors, administrators, and assigns, convenant,
understand and agree as follows:

il. To hereby release ani cischarge the Oak Ridge Institute of
Nuclear Studies, its officers, agents, and exployees from any actions,
damages or claims resulting fra: my hospitalization in said hospital and/or
any treatments and care received while in said hospital or by reascn of
my having been a patient thersin.

2. That any treatments administered to me may be experimental.

3. ‘That I have not been inflvenced in making this agreement by any
representations or statements regarding improvement in ty physical condition
or the probable results of any treatcents received, but instead expressly
assime ali risks {ncident to ay ncepitalization, care and treatment.

4, I understand that but for this agreement on my part, I would
not be accepted and admitted as a patient in said hospital.

5. I covesant thst I have carefully read the foreguing snd fully
understand the meening and contents thereof, and have executed the sare
of cy own free will and choice.

2

te Fe Fo
WITNESSES:

Mother



Coitimunlorn from Fie page 5 9/7,

tid ap tespatal DOI femelle it thw Tam
Oo oe ae
wp titelean blade, 1, De ile sud ee

amnebedl Drtaew, Ly GoW IGER8 Aa,

dow fas tilipithend (hatin te Unorgte Bamanation, Do dd a bons
moral pYaminaliow, "Here Adtme te Be me eyidence f
Lyrd deowidn, hd thers cv a fale. Newherporia. with by “VE

nactrepinans arich fae nd ad ipl

Ne speed dppeesdut don syreese
Cold, he made af thin time.” 4
Rubpttend mite dy,

LS 5968 1. bee tine ypbonk

a adits ur os m

3. 9-11-58 ppoladed

4 an 50, enhpitiont et .

5. 6-14-60, Bore barons ond Regd wo

B4B- iit out paleant mite be wey g

nee | ee atin mil _

-/3. - y ;
an 6s, jon é oe

10, 6-4 £6 a \ Prem Bp Ek (steering a Pact?
wn  washrnalere GALA. :

He B-13-F) Bere moran

Breen genio acd ance rgaleleqeemi beukarrae
anerl Tine art erclasA .



U.S. Department of Health and Human Services

Special Exposure Cohort Petition t e
under the Energy Employees Occupational Centers for Disease Control and Prevention
liiness Compensation Act Nationa! institute for Occupational Safety and Health
OMB Number: 6920-0639 Expires: 05/31/2007

Page 5 of 7

Special Exposure Cohort Petition — Form B
F Basis for Proposing that Records and information are Inadequate for individual Dose —
Complete Section F.

Complete at least one of the following entries in this section by checking the appropriate box and providing
the required information related to the selection. You are not required to complete more than one entry.

FA @ We have attached either documents or statements provided by affidavit that indicate that
radiation exposures and radiation doses potentially incurred by members of the proposed class, a
that relate to this petition, were not monitored, either through personal monitoring or through area | -

monitoring.
{Attach documents and/or affidavits to the back of the petition form.)

Describe as compietely as possible, to the extent it might be unclear, how the attached
documentation and/or affidavit(s) indicate that potential radiation exposures were not monitored.

F.2 a \/ We have attached either documents or-statements provided by affidasit that indicate that
radiation monitoring records for members of the proposed class have been lost, falsified, or
destroyed; or that there is no information regarding monitoring, source, source term, or process.
from the site where the employees worked.

{Attach documents and/or affidavits to the back of the petition form.)

Describe as completely as possible, to the extent it might be unclear, how the attached
documentation and/or affidavit(s) indicate that radiation monitoring records for members of the
proposed class have been lest, altered illegally,

The. Povwmncash EXpraurs, Suappolimiond abide 12- 2-53 po, te tat gual

fear Aide. Blood crunk courxiden wih, the risa givers
th 1H ZS. they
atte. th anita. of Haake problemas Boa” thmilad de

Part F is continued on the following page. Conlpnaide ore aa Paap

Name or Social Security Number of First Petitioner:

a A


( ( C ‘ ‘

*

ONE MARROW REPORT —
‘epartment of Pathology and Laboratory Medicine
ematology Section Extension .

SPIRATE: {KX} BIOPSY:(X] SPECIAL STAINS:{ ] SURFACE MARKERS:{ } OTHER KIND:[( j

KERERE RAK
KR EK Ke eK KEK IKK A HIRE RIKER RR RR KR RRR RK RE RRR ER RE KR EHH KK EKER KE

2 HEM NO: LOCATION: 8W DATE:. 08/13/91
Mr No - 68 a SEX: M RACE: W

-LINICAL IMPRESSION: 68 year old white male who had MDS progressing to AML. Patient s/p chemotherapy day
15. Now with fever of unknown origin

REOv'TESTING PHYSICIAN: __ “~~

*K IOUS BONE MARROW REPORT: {X] YES { ] No

‘EDICATIONS:

:GB: 9.8 HCT: 28.7 WBC: 0.7 PLATELET CT: 21k RETIC CT:
Perret Ter etrrrrerrrrrr rrr rrr Terr rt rr Tit Trttrtet trite retro ries cer eer
2TAGNOSIS: BXAMINED BY: Drs. sve . (
DIAGNOSIS:

ay! elLular bone marrow.

Derssatent acute myelologenous leukemia. See coment.

‘OMMENT :

COMMENT :

case discussed with ‘ne marrow biopsy and aspirate are hyperceltular. Approximately 60% of the

asp te cells are blasts. Circulating blasts are identified in the peripheral bload.
\

-ERIPHERAL BLOOD:

PERBLOOD .
Examination of the peripheral blood reveats mild anisocytosis and poikilocytosis. There are no significant numbers of schistocytes,
tare-* cells, teardrop forms, or ather red blood cell morphologic abnormalities. The cells appear normocytic and mildly

hy; omic. Occasional polychrematic red blood cetis are seen. No nucleated red blood cells are identified. There is no evidence
of red blood cel( agglutination or rouleaux formation. Examination of the circulating white cells reveals @ predominance of
mononuclear cells. Many of these are lymphocytes. Circulating blasts are identified in a small percentage. An occasional
reutrophil and monocyte is seen as well. The platetet count is decreased. Occasional large platelets are noted.

30NE MARROW ASPIRAT

BHASPIR

Th @ marrow aspirate fs adequate for evaluation. Examination of both the myeloid and erythroid series reveals thet there is a
left shift in the myeloid series with numerous blasts. A 200-cetl differential reveals 61% blasts, 1% promyelocytes, 1% myelocytes,
1% metamyetocytes, 3% polys, 1% eosinophils, 5% lymphocytes, 24% erythroid precursors and 3% unclassified cells. Negakaryocytes are
present in normal numbers and exhibit no morphologic abnormality.

DATE TYPED: 08/20/91 +


. This ie a lneal oan whe works
30 -vaars old. © pr. a cat
shaving trouble vith obsrructio:
- O€ Blood counts have ravnatad-a-leu!
The couets range from 2,2"



(Special Exposure Cohort Petition 97-28-05p01:44URepartment of Health and Human Services

under the Energy Employees Occupational Centers for Disease Contro! and Prevention
liness Compensation Act Nationat institute for Occupational Safety and Health

. OMB Number: 0920-0639 Expires: 05/31/2007
Special Exposure Cohort Petition — Form B Page 1 of 7

Use of this form and disclosure of Social Security Number are voluntary. Failure to use this form or disclose
this number will not result in the denial of any right, benefit, or privilege to which you may be entitled.

General Instructions on Completing this Form (complete instructions are available in a separate packet): |
Except for signatures, please PRINT ail information clearly and neatly on the form.

Please read each of Parts A — G in this form and complete the parts appropriate to you. If there is more
than one petitioner, then each petitioner should complete those sections of parts A — C of the form that apply
to them. Additional copies of the first two pages of this form are provided at the end of the form for this pur-
pose. A maximum of three petitioners is allowed.

if you need more space to provide additional information, use the continuation page provided at the end of
the form and attach the completed continuation page(s} to Form B.

If you have questions about the use of this form, please call the following NIOSH toli-free phone number and
request to speak to someone in the Office of Compensation Analysis and Support about an SEC petition:
1-800-356-4674.

0) A Labor Organization, StartatD on Page3

Ifyou (An Energy Employee (current or former), Start atC on Page 2
are: @ A Survivor (of a former Energy Employee), StartatB on Page 2
QA Representative (of a current or former Energy Employee), StartatA on Page 1

Representative Information — Complete Section A if you are authorized by an Employee or
Survivor(s) to petition on behalf of a class.

A. Are you a contact person for an organization? ( Yes (Go to A.2) No (Go to A.3)
A2 Organization information:

Name of Organization

Position of Contact Person
A.3 Name of Petition Representative:

Mr /Mrs./Ms. FirstName "Middle tnitiat Last Name

A4 Address:
a \
Street Apt # P.O. Box
~ y j

— ¢ } _

City State Zip Code
A5 Telephone Number: , : Le
AS — Email Address: - 2

A.7 1 Check the box at left to indicate you have attached to the back of this form written authorization to
petition by the survivor(s) or employee(s) indicated in Parts B or C of this form. An authorization

if you are representing a Survivor, go to Part B; if you are representing an Employee, go to Part C.

|
|
Name or Sociat Security Number of First Petitioner: ° - - oy |



“Since ast: ésen on An14-60, ba state: sthat-be Nad been feeling well and had been
"getting over” the fatigability and‘ticédnesa-he had described previously~
weight has temained stable. He-1 ad no infections since ‘is last visit.

Temperature today 37, pulse 80, respirarions 22, weight 126 pounds. Blood presaure
148/80, - Examination of the heart and lungs waa not remarkable. The liver was
ettionably palpable one fingerbreadth. The spleen was not felt. There was
increased resistance to palpation over the ‘right side of cha abdomen. However,

no masses could be delineated. There were tiny, wshotty axillary nodes. No other
adenopathy was noted,

Femoglobin 34.2 gm, hematocrit 4S, BBC 2,600, Piatelet count 422,500. Differ~
e:.tial count by tha undersigned showed Si nentrophils, 45 lymphoeytes, 14 monocytes, .
i aosinophiis, Platelets appeared. increased. -Red cell morphology was’not ~ wn
redarkable. There appeared to be some dntrease in reticulocytes. A bone natrow
aspiration showed a considerabie increase in fat spaces, I considered the martow
particles 24 hyperplastic in appearance. Megakaryoevtes were present in normal .
numbers. The following differential count was obtained ty the undercigned:
blasts 3.5, promyelocytea 6, myelocytes.9, eosinophilic myelocrtes 1, meta- .
myelocytes 21, adult newt bophilerl6;-gosinsphils 0.5, basophils 0.5, lymphocytes
15.5, plasma ceils 0.5, pronormebiasts 2, ard normobleats 25. The HE ratio was
2.2:1, The marrow is considered abnormal but not disgnostic,

As yet no cause has been found for the patient's leukopenia and gramlocytopenia,
It will be helpful te contime to follow hia with periodic bone marrow aspirations.

The patient is te return as an outpatient on B-1G-60, at which time he is to have
a G3C and platelet count.

bbe



ry Flosp. No. '

_ This patient was referred to us beenuse of the discovary of a leukopenia. He
was in tae Oak Ridge Hospital from August. llth to 22nd as a patient of Dr.

\ because of difficulty vith his nasopharynx of some months duration. He
yes been having obstrection of the eustachian tubes, a feeling of fulln-ss am
discomfort in the frontal region, and in his ears. He has been told that he
has lymphoid hyperplasia and that this accouwes fer his symptoms. During the
few weeks before he wes admitted to the Oak Ridge Hospirsl he was given Achro-
mycin, Panmycin, Penicillin, an antihistomine, and Privina nose drops. It was
after ne got inte the hospi'al that he was found to have a white count below
2,000. Since then he has nad several white counts which have ranced from
2300 to 24M. A count dene about a week ogy at the plant snowed 3,200. The
prtient has heen Cneiing weil and has so complaints wxeesl for the discomfort
related un toe nasopharynx.

In the past he has been treated ty Dr. ‘for some gastrointestinal

symptoms, chiefly distress after mals. Ne has been given a la chatke
tsblet and a small «nite tablet with aa Ron it. Re takes these inrermitt,
when he s¢ens to neei them. Ne was also found, a fo years ae by t
to have small kidney stones but these have < im so trouble
does not have an istery of asthma or hay £ » or any Known
savs that ork wpcets him. He has never had any type of arshri

with his joints

Ne reviewed Lhe counts

site count

an phraeiesi exac bat not ill.
f t of the left
i of frothy
ara smail, sxft,

these seer disti

sensitiv Lo on
There seems to be
a leuko-emia, sor is ¥
decicec to de a bone marrow
that the patient cer
that the cep rt be sent to us. %
this time

ef any infection
ing which would
ination and thi
waite count ina
diagnosis could ve

No specific

pe

Letter to physician: Yea No

- be -
Date as Gufs z



Special Exposure Conort Petition U.S. Department of Health and Human Services

der the E Empi s Occupational Centers for Disease Control and Prevention
Tiness Compensation Act ue National Institute for Occupational Safety and Health
OMB Number: 0920-0639 Expires: 05/31/2007

Special Exposure Cohort Petition — Form B Page 6 of 7

F.3  iMWe have attached a report from a health physicist or other individual with expertise in
radiation dose reconstruction documenting the limitations of existing DOE or AWE records on
fadiation exposures at the facility, as relevant to the petition. The report specifies the basis for
believing these documented limitations might prevent the completion of dose reconstructions for
members of the class under 42 CFR Part 82 and related NIOSH technical implementation
guidelines.

(Attach report to the back of the petition form.)

F.4 Q ie have attached a scientific or technical report, issued by a government agency of the
Executive Branch of Government or the General Accounting Office, the Nuclear Regulatory
Commission, or the Defense Nuclear Facilities Safety Board, or published in a peer-reviewed
journal, that identifies dosimetry and related information that are unavailable (due to either a lack
of monitoring or the destruction or loss of records) for estimating the radiation doses of
employees covered by the petition.

(Attach report to the back of the petition form.)

Go to Part G.
G Signature of Person(s) Submitting this Petition — Complete Section G. .
All Petitioners should sign and date the petition. A maximum of three persons may sign the petition.
a 7 ry
_ : a5, Joos
Signature ite
Signature Date
Signature Date
Notice: Any person who knowingly makes any false statement, misrepresentation, concealment of

fact or any other act of fraud to obtain compensation as provided under EEOICPA or who
knowingly accepts compensation fo which that person is not entitled is subject to civil or
administrative remedies as well as felony criminal prosecution and may, under appropriate
criminal provisions, be punished by a fine or imprisonment or both. | affirm that the information
provided on this form is accurate and true.

Send this form to: SEC Petition

Office of Compensation Analysis and Support

NIOSH ppe

4676 Columbia Parkway, MS-C-47

Cincinnati, OH 45226

If there are additional petitioners, they must complete the Appendix Forms for additional petitioners.
The Appendix forms are located at the end of this document.

Name or Social Security Number of First Petitioner:


Name: ¢ Payroll No; ‘

Dept. or Division: Math Panel Supervisor:

The Radiation Exposure Record of the above named employee has been summarized as

follows:
TSR BS DM aL : DP Fru
Report "aso 8600 ay
Involved #7850 330
weekly
Quarter: vo Coxx) | “to date
—__—__ Wk.
Recommended G. ° . 0 °
Adjustment. Yo date” “pos
Remarks: Evidence of light 100% -- consultetion with?" reveals

bo pest history of radiation exposure. In view of seis, @ xyemwumended dose

of O is in order.

Noted: Investigated by: 2 Date:_19-2-58
~ (Supervisory (HP Representative)
ae = ane ene —
Approved: é Received & Recorded: ferye dV
‘ . a Le
1% -23-"% Noted By: a)
¥ :

Distribution: white Copy = agp, Personnel Monitering; Yellow Copy - Supervisor;
Pink Copy - Investigate:



OSTEATTENY NOTE

oe re Eospitel No. ‘

_. _ ‘a’returried for followup of a long-standing leukopenia of uncertain
etiology. Since his last visit on 9-16-42 he said "I can't think of any~
thing intereyting to report." He hay had no further hack trouble and no
further infections. Ee said that his strength was-good and he hat a lot
of energy. He is working every day. He stated that he had no fatigebiilty
without good cause. ee

Tonprraiuré 36.4, pilse 76, and respirations 24,°°Weight 13< pounds. Tbe
patient looked well. There yas a I oo flat “tonsillar nodo® bilaterally.
There was also a prominent salivary gland in the submandibular erca. No
ather adencpathy wao noted, The liver wes palpable 1 fingerbreath beneath
the right costal margin. ‘There was no splenmegaly, The petient's eblaren
is quite macular and palpition was rather difficult. REG 4,830,000 with

a hemoglobin of 15.3 g and & hematocrit of 45%. WET 3,050. Platelet. count
267,000, Sedimentation rate 10 um per hour, corrected, I obtained the
following differential count: segmented neutrophils 40%, lymphocytes 45%,
3 10%, eosinovhiles 1%, hasophiles 1%, and a‘normsi mopomuélear
wills 36, Hany of the lynphoytes were moderately large cells with pale
eytoplasm and appearsd to te abnormally fragile, Th.se abnormal mono~
muclear cells were immature forms. Two Kad apparent micleoli, Fed cell
norphol-zy was not remarkable, Platelets appeared to be increased and a
few scattered abnormal forms were seen, Raticuiccytea vere present in
normal wankers, ‘There vere scattered smidge celis, A sternal marrow
aspiration vas performed. Very few particles were seen grossly, The
marroy smears showed a few particles with rather vuried cellvlacity and

nated oa others tnere was appreciable gramilopeissis with gone Je2s shift.
Tgmphocyies and plasma cells were considered to be increased and there were

smudge forms and bere miclei, The marrow sections also revealed marked
variability in cellularity, sase areas appearing distinctly hyreplastic.

aspirations, the marrow 1

3 given en appointment to return es an outpatiert on 9-12-43 when
the C&C and platele. count will be repeeted.

@ normal mmber of megakaryocytes, In some areas erythroid activity prodani-~
scattered immature cslla which were difficult to clasaify as well as scattered

Iron steins showed an increased amount cf intracellular iron, As on previous
s felt to be abnormal “ut without diagnostic features.
ae sete sO er ae nes



BENTAAL MEDINTKE
i. EUBENE GROWN, He. D.
ROBERT H. TRANDH. o. 3.

ALkIaMIN @. HCRDEL BLD.
BERNARD WALLKAM, &. D.
AMES OF CHRIETT, MLO.
THARKER A SRAKE, MW. OL

RASTROENTEROLORY.

4 Zpéoing soungoes. x. B
4BrIN T RALAMROR, M.D.
Bhinee acMOnD eee

tosemnaooy a
RERAL olstaatE
1, GARLAND HIRKOON, I. 0,

tartcrion* praaee.

Bs
WILLIAM MARINE, Be, 0.

HYPERTENSION Repeat
SAAWAN GO. WATERS fr, DL

canpiowgay
. BRECK LoeUt, &. Oo.

EMORY UNIVERSITY SLINIC FNMA MORE. MOB

o.
2. wogorin CORES UR. 9.

wenaToosT

CHAS. MW, HYAULET, oR. Mo.
SHANE. CORLEY, aR,
AMES W. LER 31
maton roataR ie. 5.

neurotoay
HERBERT 2. KART, HD.

DEPARTMENT OF INTERNAL MEDICINE
ATLANTA, BEOROIA 303523

|. MOXINMEY, 4. 2.

DtRMarevoar
MONET LANERT, Ho.

MECiEAL ONES?
ROUNL MCLEAN, wD.

November 24, 1965
Re: = wee
Dear és
\ - -
Thank you very much for directing o . 4 our llemato ogy
Section. We nave recentiy been over him carefully without shedding

any new Light cn his leukopenia.

However,
between the
other areas
that he
counts
up and I will
monts.

his bone marrow
trabeculae
the cellular:
is slow i

are quite
certainiy.

wer

devel

g in for regular follow -
there are any new develop

Sinecrely,


E.1
E.2

E3

E.4

E.5

Special Exposure Cohort Petition U.S. Department of Health and Human Services

under the Energy Employees Occupational
Itiness Compensation Act

Special Exposure Cohort Petition — Form B

Centers for Disease Control and Prevention
National Institute for Occupational Safety and Health

OMB Number: 0920-0639 Expires: 05/31/2007
Page 4 of 7

Proposed Definition of Employee Class Covered by Petition — Complete Section E.
Name of DOE or AWE Facility: Lia PLANT. Caw Ridee TENA.

Locations at the Facility relevant to this petition:

WORKED WsTH AND LOCATED NEAR ByOL OGIST

List job titles and/or job duties of employees included in the class. In addition, you can list by
name any individuals other than petitioners identified on this form who you believe should be

included in this class:
STATISTICAN
STATISTICAL ANALYSIS OF BiolOBICAL Bx PERIMENTS
RELATED TO RADIATION

Employment Dates relevant to this petition:

stat _/. 3/-/451 End .6-30- _

Start End

Start - End

is the petition based on one or more unmonitored, unrecorded, or inadequately monitored $f
recorded exposure incidents?: & Yes G No

if yes, provide the date(s) of the incident(s) and a complete description (attach additional pages
as necessary): .

_ PERSONNEL EXPOSURE SUPPLEMENT DATED 12 -23- L958. Hee
SHIS RAD(ATION EYPOSURE RECORD Was FOR

Bugine THE Fest QvARTER CAN. FEB, Maced) 178, At This Tine. . 7

HAL_BEEN SICK sMITH HEALTH PROBLEMS , THCLUDING A LOW JwurTE Blopp COUNT FoR

MAM MONTHS THaT WERE CAUSED BY THIS RADIATION Ex POSURE. _ AS_WELL AS HIS

DeTDRS ERE QoWCeRNED And PUEELED GRDUT rue piIseT OF MIS JLLWESS.
1_BtrevE THAT 1F [HAD CONSULTED wiTH [ABOUT THIS

RERDING , THEN \_ wowed Have Fokb Hid AigoltT HiS ILLNESS AWD LOW WHITE

BiboD COUNT, THE METER BADGE WAS phRNTO ReconD RADMTIOM EXPOSURES THAT Je]
SAE NST AMARE of. RADIATIDN ChyieT GE SEEN OR BEEFELT AT THE Time oF EXPOSURE.
—Ab80, T How BELIEVE THAT THE ACNE DIRECTOR oF THe MaTheMaTiCs Pawel AT THE DME,
FARNED OF THis EXPOSURE AND GlORGE“s Low WHITE Blood Count RFTER
Tbe L9S8 ft) THS ISTHE RE#SON THaT BE TRANSFERED GEORGE Eom Hold. Bjeio:
L OBJECTED Td THIS TRAWSFER » AJOB fe ‘ 1 aLs=16
Hal To BE CREATED Be: }

THE ABOVE PERSONNEL EXPOSUR: SUPPLEMT ANDTHE CHANEE TozeRol bach)
Go to Part F.

Name or Social Security Number of First Petitioner:



x

U.S. Department of Health and Human Services

Special Exposure Cohort Petition x t ne
yees Occu i Centers for Disease Control and Prevention

Thee Conneray Emeroys ationa National institute for Occupational Safety and Health
OMB Number: 0920-0639 Expires: 05/31/2007

Special Exposure Cohort Petition — Form B Page 2 of 7

Survivor Information — Complete Secti

B.1 Name of Survivor:

Mr/MrséMis. First Name Middle Initial Last Name
B.2 Social Security Number of Survivor:
B.3 Address of Survivor:

Street_ a ° Apt # P.O. Box
City State Zip Code
B.4 Telephone Number of Survivor: —
B.S Email Address of Survivor: : oe j
B.6 Relationship to Employee: a Spouse Q Son/Daughter Q Parent
Q Grandparent Q Grandchild
Go to Part C.

Employee Information — Complete Section C UNLESS you are a labor organization.

C.1 Name of Employee:

Mr/Mrs./Ms. FirstName Middle Initial Last Name ait
. (avert

C.2 Former Name of Employee (e.g., maiden name/iegal name change/other):

Mr/Mrs./Ms. First Name Middie initial Last Name
C.3 Social Security Number of Employee:

CA Address of Employee (if living): DECEASED

Street Apt # P.O. Box

City State Zip Code
C.5 Telephone Number of Employee: ¢ ) -

C.6 Email Address of Employee:

C7 Employment Information Related to Petition:,
C.7a Employee Number {if known): BES _.
12, 1 co 1257 LOL MEY

C.7b Dates of Employment: stat ¢ yaad ees 9 End ‘TLPES

C.7¢ Employer Name: - _ H
b——_______
C.7d Work Site Location: _V- {2 x-/0

C.7e Supervisors Name. Y-/2, a
Xie Rg
Go to Part E.

Name or Sociai Security Number of First Petitioner: _



BONE MARRG« REPORT.

. i
HOSPITAL MO, nasser

PATHOLOGY HO.
6/14/8n 11.50 a.m.

~ TIME nae ee ae
RANE — a EY DATE WE

sory Sternure, ORTARED RY OR,

Guinicat, We Reseow —~ — wee
Follcving local anesthesia apyroximately 2 mi. of material was aspirated with

TECONH Ror itsermnfott to tHe Patient, — NUTIET LATE PREICES OTS TINIE TE Ue RU SOCAL
Vloud, Films wers prepsred and remainder concentrated for histulogic sect

DekemeTis ..

. ‘ stained films shew a good smnpling of marrow. ‘here is 3. distinct inercese
is fat but clinical marrow cells are alse available for study Megskarvoevtes appear
to te adngiate. The M.EB. ratio is approximately $:1. The matuvatica of the frantic-
cytic series is orderly. There may be a mild left shift. Regeneration of red refis

bs Bormecvtiz, On some films there are some naked nuciet that arcn't identifiable

and there is an imapressinn of ‘ncrrased unmbers af Iymphocries in come

Sections of the marrow shew a normal marrow pattern with hematopoietic elements
interspersed a:nong fat spsces. Cellularity shows a greater range than usual wiih
some hypotrilular areas merging Into areas that in themselves are hynerc: 7
Megakaryocyier ate found in spproximately nevaal nur:bers. No ceplacement of
marrow by teovlasm at fibrosia is seen. lron-positiv: material is present in nara!
sy slightly inerezced amounts.

No pathognomonic alteratia:. in mar_ow but a distincti
variafion in celhdari
penia which has per

whormmal sar
At the present time flere is ne expla
aver the past several yeers

ars.

RAAtION fer the leuke -



“ QUIEAEEENT. NOTE

“2-35-O% . _ Hospital Na.

ee etturned for follow-up of leukopenia. of ‘uncertain etiology. Since .ia Inst

_wiait On 9-12-53, be wtatod that he hed been “Soing real ool". “He has haz no

“Anfsetions. "Be has haa no recurrence of beck pain,” He added that he fe sneezing
quite « dit this winter and feels that he hos tome type of allergy. The symptom
uswally is present in the sorning ent wis deseribed as “not mich of 0 nuisance”. No
other symptoms were elicited. ce tee

Tanperature 36.8, pulse 34 and respirations 20. Weight 131 pounds. The patient

looked quite well. There were a few firn, tiny, freely mvable josterior cervicel nales

bilsternlly. There were tvo or three similar but pea-sized nodes in the left uxiila.

No other noles were palpable. The Liver is palpable 1/2 to 1 fingerbresdth beneath

tne right costal morgin. Noweves, as the organ percussed equally Ice in the chest T

did not believe tint it wns enlarged. The spleen tip wes ovcstionably palradle when

the patient was placed in the right bteral poettion. R87 5,070,000 vith a Remoglobin

of 15.4 gn ond a hermteerit of LT4. Wee 2,875. Platelet count 260,000. Sedinentation
rate 9 msfhr . corrected.

The yetient combimucs te ao very vell clinically. “There ios @ ltttle chaney in his — ~
peripberni blow values. Before he left 1 sternel mrrov aspiration was jerformed,
X told the patient I vould cali hin if the smear shewed ary significant abnormality.

Subsequently the marrov was interpreted sy Dr. Andrews as being slightly fatty with
Slight increase in plasm eclis and in iron, He hai not felt that anv centgnieg ties
xveretemrnble, *

I gave ‘an appointment to return ag an outpatient on 5-13-54 shen a TAC and

Platelet count will be repeated.