United States Nuclear Regulatory Commission - Protecting People and the Environment

Event Notification Report for March 8, 2013

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
03/07/2013 - 03/08/2013

** EVENT NUMBERS **


48687 48793 48810 48811 48812

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Power Reactor Event Number: 48687
Facility: WATERFORD
Region: 4 State: LA
Unit: [3] [ ] [ ]
RX Type: [3] CE
NRC Notified By: JOE WILLIAMS
HQ OPS Officer: CHARLES TEAL
Notification Date: 01/21/2013
Notification Time: 19:55 [ET]
Event Date: 01/21/2013
Event Time: 15:51 [CST]
Last Update Date: 03/07/2013
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
50.72(b)(3)(iv)(A) - VALID SPECIF SYS ACTUATION
Person (Organization):
MICHAEL VASQUEZ (R4DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 A/R Y 91 Power Operation 0 Hot Standby

Event Text

AUTOMATIC REACTOR TRIP DUE TO LOW STEAM GENERATOR LEVEL

"At 15:51 CST, Waterford 3 experienced an uncomplicated automatic reactor trip from 84.5% reactor power. The actuations of the Reactor Protection System (RPS) and the Emergency Feedwater Actuation System (EFAS) resulted from Steam Generator #1 Low Level, which is at a nominal 27.4% narrow range setpoint. Safety systems responded as expected.

"All three (3) Emergency Feedwater Pumps started and injected into Steam Generator #1. Auxiliary Feedwater pump has been started, feeding both Steam Generators (#1 and #2) at levels above the EFAS low level setpoint. All control rods inserted by the automatic RPS actuation. Electrical power is being supplied from normal off-site power and condenser vacuum is available for Steam Generator heat removal via the Steam Dump Bypass Control system. There are no safety systems out of service or inoperable, nor any safety system TS [Technical Specification] LCO [Limiting Condition for Operation] actions entered.

"The cause of the Steam Generator #1 Low Level condition, and associated Reactor Trip, is under investigation. This event occurred during the initial power escalation from refuel outage RF18, after attempting to place C Heater Drain Pump (HDP), the first of three, into service. After starting, C HDP tripped for a reason not yet verified. Subsequently, based on initial Control Room operator observations, the Steam Generator #1 Main Feedwater control valve position was observed to be at 10-20% open, but with an open position demand signal of 100%. Main Feedwater response to the reactor trip (Reactor Trip Override) was as expected."

The NRC Resident Inspector has been informed.

* * * UPDATE FROM WILLIAM HARDIN TO PETE SNYDER AT 1645 EST ON 3/7/13 * * *

The original reactor power level stated in the report should be 91% in lieu of 84.5%. This information has been changed in the event heading.

The licensee notified the NRC Resident Inspector. Notified R4DO (Werner).

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Agreement State Event Number: 48793
Rep Org: VIRGINIA RAD MATERIALS PROGRAM
Licensee: CARILION CLINIC
Region: 1
City: ROANOKE State: VA
County:
License #: 770-051-1
Agreement: Y
Docket:
NRC Notified By: CHARLES COLEMAN
HQ OPS Officer: CHARLES TEAL
Notification Date: 02/28/2013
Notification Time: 16:22 [ET]
Event Date: 02/27/2013
Event Time: [EST]
Last Update Date: 02/28/2013
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
ART BURRITT (R1DO)
FSME EVENT RESOURCE (EMAI)

Event Text

PATIENT RECEIVED LESS THAN PRESCRIBED DOSE TO LIVER

The following was received via fax from the Commonwealth of Virginia:

"On February 27, 2013, a patient was treated with Y-90 microspheres (SIRTeX SIR-Spheres) for a liver lesion. The prescribed activity was 11.3 millicuries. Measurements of the residual activity in the delivery system indicated only 8.4 millicuries was delivered to the patient, resulting in a total dose differing from the prescribed dose by 25.9 percent. Notifications were made to the referring physician and patient. The licensee will submit a written report of the event within 15 days."

VA Event Report: VA-13-0003

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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Non-Agreement State Event Number: 48810
Rep Org: ST. JOSEPH HEALTH CENTER
Licensee: ST. JOSEPH HEALTH CENTER
Region: 3
City: KANSAS CITY State: MO
County:
License #: 24-02704-01
Agreement: N
Docket:
NRC Notified By: MARCIA WEST
HQ OPS Officer: PETE SNYDER
Notification Date: 03/06/2013
Notification Time: 15:58 [ET]
Event Date: 03/05/2013
Event Time: [CST]
Last Update Date: 03/06/2013
Emergency Class: NON EMERGENCY
10 CFR Section:
OTHER UNSPEC REQMNT
Person (Organization):
NICK VALOS (R3DO)
FSME EVENT RESOURCE (EMAI)

Event Text

CONTRACT AUDIT DISCOVERED PHYSICIAN NOT LISTED ON LICENSE

During an audit by Cardinal Health on behalf of St. Josephs Health Center it was discovered that a physician who was not listed on the current license has signed approximately 20 qualified medical procedures (QMP). The physician had been listed on earlier licenses but apparently was removed from the license in 2005. A technologist at St. Josephs said that at one point a number of oncologists were removed from the license. This physician may have been inadvertently removed at that time.

The licensee's representative is reporting this as a violation of 10 CFR 35.300 since a physician not listed on the license signed QMP. Cardinal Health will continue to investigate.

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Power Reactor Event Number: 48811
Facility: SUSQUEHANNA
Region: 1 State: PA
Unit: [ ] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: DAVE BORGER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 03/07/2013
Notification Time: 03:36 [ET]
Event Date: 03/07/2013
Event Time: 01:35 [EST]
Last Update Date: 03/07/2013
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
BLAKE WELLING (R1DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 99 Power Operation 99 Power Operation

Event Text

HIGH PRESSURE COOLANT INJECTION DECLARED INOPERABLE

"At 0135 EST, Unit 2 High Pressure Coolant Injection (HPCI) system was declared inoperable, and LCO 3.5.1 entered, due to its turbine steam exhaust valve failing in the closed position during the quarterly valve exercising surveillance. The supply breaker tripped when the opening stroke was attempted. The valve was verified to have remained fully closed via the manual operator. HPCI will not automatically start with this valve closed.

"HPCI is a single train Emergency Core Cooling Safety [ECCS] system. This event results in the loss of an entire safety function which requires an 8 hour ENS notification in accordance with 10CFR50.72(b)(3)(v) and the guidance provided under NUREG-1022, rev. 2.

"There are no other ECCS systems presently out of service."

The licensee has notified the NRC Resident Inspector.

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Power Reactor Event Number: 48812
Facility: CLINTON
Region: 3 State: IL
Unit: [1] [ ] [ ]
RX Type: [1] GE-6
NRC Notified By: DAN HUNT
HQ OPS Officer: PETE SNYDER
Notification Date: 03/07/2013
Notification Time: 11:52 [ET]
Event Date: 03/07/2013
Event Time: 07:56 [CST]
Last Update Date: 03/07/2013
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(iv)(B) - RPS ACTUATION - CRITICAL
Person (Organization):
NICK VALOS (R3DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
1 A/R Y 97 Power Operation 0 Hot Shutdown

Event Text

AUTOMATIC REACTOR SCRAM ON GENERATOR TRIP/TURBINE TRIP

"While operating at rated electrical power, a main generator trip and subsequent turbine trip resulted in a reactor scram. The cause of the generator trip is under investigation. All systems operated as expected with no complications. The plant is stable in Mode 3."

The licensee notified the NRC Resident Inspector and the State of Illinois.

Page Last Reviewed/Updated Friday, March 08, 2013
Friday, March 08, 2013