United States Nuclear Regulatory Commission - Protecting People and the Environment

Event Notification Report for April 23, 2012

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
04/20/2012 - 04/23/2012

** EVENT NUMBERS **


47841 47850 47856 47857 47858

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Agreement State Event Number: 47841
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: PINNACLE HEALTH HOSPITALS
Region: 1
City: CAMP HILL State: PA
County:
License #: PA-0037
Agreement: Y
Docket:
NRC Notified By: DAVID ALLARD
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 04/17/2012
Notification Time: 10:53 [ET]
Event Date: 04/13/2012
Event Time: [EDT]
Last Update Date: 04/17/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JUDY JOUSTRA (R1DO)
ANGELA MCINTOSH (FSME)

Event Text

AGREEMENT STATE REPORT - RADIOTHERAPY UNDERDOSE

The following report was received via fax:

"On April 13, 2012, a patient was to receive a prescribed dose of 100 mCi of iodine-131 (I-131) for thyroid cancer. Two capsules of I-131 were received from the radiopharmacy in a single vial which was assayed to assure proper dose prior to administering to the patient. The patient was given the contents of the vial for treatment and the treatment was considered complete. The Nuclear Medicine staff prepared the remaining container for return to the radiopharmacy on Monday April 16, 2012. The radiopharmacy picked up the I-131 container and returned it to their facility. Upon inspection of the returned package, the radiopharmacy discovered that one of the two capsules intended for the treatment remained lodged in the vial. The radiopharmacy informed Tristan and the RSO at 12:30 EDT on Monday April 16, 2012. The patient received 50 mCi of the intended 100 mCi dose.

"Patient and referring physician are in the process of being notified. The [PA] Department [of Radiation Protection] plans to do a reactive inspection on April 17, 2012."

PA Event ID: PA120013

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.

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Power Reactor Event Number: 47850
Facility: LIMERICK
Region: 1 State: PA
Unit: [1] [ ] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: BRANDON SHULTZ
HQ OPS Officer: KARL DIEDERICH
Notification Date: 04/19/2012
Notification Time: 11:10 [ET]
Event Date: 04/19/2012
Event Time: 07:53 [EDT]
Last Update Date: 04/20/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(xiii) - LOSS COMM/ASMT/RESPONSE
Person (Organization):
JUDY JOUSTRA (R1DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 M/R Y 100 Power Operation 0 Hot Shutdown

Event Text

MANUAL REACTOR SCRAM FOLLOWING LOSS OF RECIRCULATION PUMPS

"Limerick Unit 1 was manually scrammed from 100% power at 0753 hours on 4/19/12 in accordance with plant procedure OT-112 'Recirculation Pump Trip' when both 1A and 1B Recirculation Pump Adjustable Speed Drives (ASDs) tripped due to an electrical fault affecting the 144D and 114A non-safety related 480V Load Centers. The shutdown was normal and the plant is stable in Hot Shutdown with normal pressure control via the Main Steam Bypass valves to the main condenser and normal level control using feedwater. The manual RPS actuation is reportable under 10 CFR 50.72(b)(2).

"The Technical Support Center (TSC) Normal Air conditioning systems shut down due to loss of power from the 144D Load Center. The loss of power also affects the flow indication for the Emergency Ventilation system. This is considered a Loss of Emergency Assessment Capability, and reportable under 10 CFR 50.72(b)(3)(xiii). The Emergency TSC Ventilation system is available but flow cannot be verified. During a required activation the TSC, responders would report to the TSC. If conditions required use of the Emergency Ventilation system, the Station Emergency Director would assess habitability in accordance with Station procedures. TSC relocation of personnel would be directed as required until such time that the TSC ventilation system is returned to service"

The licensee notified the NRC Resident Inspector.

* * * UPDATE AT 1726 ON 4/20/2012 FROM BRANDON SHULTZ TO MARK ABRAMOVITZ * * *

"The Technical Support Center (TSC) 144D load center has been re-energized, restoring the emergency ventilation flow indication and emergency assessment capability to its normal stand-by condition."

The switchgear was inspected for any potential grounds and then reenergized at approximately 0800 EDT on 4/20/2023.

The licensee notified the NRC Resident Inspector.

Notified the R1DO (Joustra).

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Power Reactor Event Number: 47856
Facility: SAN ONOFRE
Region: 4 State: CA
Unit: [ ] [2] [ ]
RX Type: [1] W-3-LP,[2] CE,[3] CE
NRC Notified By: BILL POIER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 04/20/2012
Notification Time: 16:29 [ET]
Event Date: 04/20/2012
Event Time: 12:49 [PDT]
Last Update Date: 04/20/2012
Emergency Class: UNUSUAL EVENT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
WILLIAM RULAND (NRR)
BILL GOTT (IRD)
ERIC LEEDS (NRR)
ELMO COLLINS (R4 R)
RYAN LANTZ (R4)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Cold Shutdown 0 Cold Shutdown

Event Text

UNUSUAL EVENT DECLARED DUE TO ELECTRICAL PANEL FIRE IN TURBINE BUILDING

San Onofre Unit 2 declared an Unusual Event at 1249 PDT today due to an electrical fire within a fire detection panel (2L319) in the Unit 2 turbine building. The fire was declared extinguished at 1314 PDT after the panel was de-energized. The location of the fire had no impact on plant operation, equipment, or personnel safety. No offsite assistance was necessary. The licensee exited the Unusual Event at 1341 PDT after the licensee confirmed that the fire was terminated and there was no ongoing risk to the plant.

The licensee notified state and local authorities and the NRC Resident Inspector.

The NRC Operations Center notified other Federal Agencies (DHS SWO, FEMA Ops, DHS NICC, and NuclearSSA via e-mail).

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Power Reactor Event Number: 47857
Facility: HARRIS
Region: 2 State: NC
Unit: [1] [ ] [ ]
RX Type: [1] W-3-LP
NRC Notified By: AL BOSTIC
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 04/21/2012
Notification Time: 12:45 [ET]
Event Date: 04/21/2012
Event Time: 05:15 [EDT]
Last Update Date: 04/21/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
REBECCA NEASE (R2DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N N 0 Hot Shutdown 0 Hot Shutdown

Event Text

MAIN STEAM ISOLATION VALVES FAIL TO SHUT

"At approximately 0515 EDT on April 21, 2012, the Harris Nuclear Plant [HNP] was in the process of a normal plant shutdown for a refueling outage. HNP was at 0% power in Mode 4. During OST-1046, MSIV Operability Test, 'B' and 'C' Main Steam Isolation Valves (MSIV), failed to close from the main control board.

"At 0648 EDT an April 21, 2012 'B' MSIV shut immediately after the instrument air supply was isolated.

"At 0938 EDT an April 21, 2012 'C' MSIV shut after the instrument air supply was isolated.

"The cause of the equipment failure is not yet known but is currently being investigated. This report is being made in accordance with 10 CFR 50.72 (b)(3)(v)(C), inability to isolate and mitigate a radioactive release, and 10 CFR 50.72 (b)(3)(v)(D), a condition which could have prevented the fulfillment of a safety function to mitigate the consequences of an accident. The plant continues to remain shutdown at 0% power. Other equipment functioned as expected including the turbine isolation valves."

The licensee notified the NRC Resident Inspector.

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Power Reactor Event Number: 47858
Facility: DIABLO CANYON
Region: 4 State: CA
Unit: [1] [2] [ ]
RX Type: [1] W-4-LP,[2] W-4-LP
NRC Notified By: DAN STERMER
HQ OPS Officer: PETE SNYDER
Notification Date: 04/22/2012
Notification Time: 02:50 [ET]
Event Date: 04/21/2012
Event Time: 16:15 [PDT]
Last Update Date: 04/22/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
INFORMATION ONLY
Person (Organization):
NEIL OKEEFE (R4DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 N Y 82 Power Operation 20 Power Operation
2 N Y 100 Power Operation 100 Power Operation

Event Text

APPARENT PHASE IMBALANCE BETWEEN NORMAL AND ALTERNATE POWER CIRCUITS

"On April 21, 2012, at 1615 PDT, Diablo Canyon Power Plant (DCPP) operators identified that an attempted manual transfer of the Unit 1 AC power sources from the normal offsite circuit (500 kv) to the alternate offsite circuit (230 kv) failed.

"The attempted manual transfer of the offsite power source from the normal 500 kv to the alternate 230 kv was a planned activity to shut down Unit 1 for its 17th refueling outage. The failure to manually transfer was concluded to be caused by an indicated out of phase condition between the 500 kv and 230 kv system. DCPP control transfer systems prevent paralleling and transferring the power supplies from the normal to alternate offsite circuit with an out of phase condition. The offsite AC power sources remain capable of being manually transferred from the normal to the alternate source by way of transferring to diesels as an intermediate step.

"The 230 kv system ability to perform its accident mitigation safety function following a reactor trip or safety injection was not affected by the inability to perform a direct manual transfer from the 500 kv offsite power system.

"DCPP staff are currently troubleshooting the out of phase indication and will provide an update when the cause is concluded.

"The licensee notified the NRC Resident Inspector."

Page Last Reviewed/Updated Monday, April 23, 2012
Monday, April 23, 2012