Event Notification Report for September 22, 2016

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/21/2016 - 09/22/2016

** EVENT NUMBERS **


52237 52238 52254

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Agreement State Event Number: 52237
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: EPHRATA COMMUNITY HOSPITAL
Region: 1
City: EPHRATA State: PA
County:
License #: PA-0038
Agreement: Y
Docket:
NRC Notified By: JOSEPH MELNIC
HQ OPS Officer: JEFF HERRERA
Notification Date: 09/13/2016
Notification Time: 11:00 [ET]
Event Date: 09/01/2016
Event Time: [EDT]
Last Update Date: 09/13/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
JAMES NOGGLE (R1DO)
NMSS_EVENTS_NOTIFIC (EMAI)
DAN COLLINS (NMSS)

Event Text

AGREEMENT STATE REPORT - PATIENT DOSE TO THE SKIN THAT EXCEEDED 50 REM

The following report was received from the Pennsylvania DEP Bureau of Radiation Protection via email:

"On September 12, 2016, the Department [Pennsylvania Department of Environmental Protection] was notified by Ephrata Community Hospital that while injecting technetium-99m (Tc-99m) into a patient, a leak occurred in the delivery system resulting in skin contamination and a dose to the patient's skin estimated to be greater than 50 rem. It is reportable per 10 CFR 35.3045(a)(3).

"A 29 millicurie (mCi) Tc-99m dose was ordered for a patient bone scan. While injecting the dose into the patient's IV port the technologist noticed leakage and immediately stopped the injection. The patient's arm was wiped and cleaned with gauze several times. Ephrata Hospital estimates the skin contamination from that (unknown) residual activity to be approximately 15.8 mCi, resulting in a dose to the patient's skin greater than 50 rem."

Event Report ID No.: PA160025

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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Agreement State Event Number: 52238
Rep Org: LOUISIANA RADIATION PROTECTION DIV
Licensee: EXXONMOBIL
Region: 4
City: BATON ROUGE State: LA
County:
License #: LA-2349-L01
Agreement: Y
Docket:
NRC Notified By: RUSSELL CLARK
HQ OPS Officer: STEVEN VITTO
Notification Date: 09/13/2016
Notification Time: 17:00 [ET]
Event Date: 09/13/2016
Event Time: 09:10 [CDT]
Last Update Date: 09/13/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RAY AZUA (R4DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

AGREEMENT STATE REPORT - DENSITY GAUGE EQUIPMENT MALFUNCTION

The following was received from the State of Louisiana via email:

"On September 13, 2016, at approximately 0910, Central Standard Time, Radiation Safety Officer (RSO) of ExxonMobil notified LDEQ [Louisiana Department of Environmental Quality] of a potential equipment malfunction. A Ronan Model SA-1-C5 level/density gauge, device serial number LA8122A, containing a 100 mCi sealed source of Cs-137 and installed on D-Line Low Pressure Separator Vessel, V-231, was undergoing a routine annual shutter test when the gauge shutter became stuck in the open position. The RSO called Ronan and left the manufacturer a message requesting service and repair of the gauge. This is not an emergency. ExxonMobil Radiation Safety Office staff are monitoring the vessel condition and have the situation under control. There is no potential for off-site exposure."

Event Report ID NO.: LA160009

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Power Reactor Event Number: 52254
Facility: INDIAN POINT
Region: 1 State: NY
Unit: [2] [ ] [ ]
RX Type: [2] W-4-LP,[3] W-4-LP
NRC Notified By: CHRIS HASSENBEIN
HQ OPS Officer: JEFF HERRERA
Notification Date: 09/21/2016
Notification Time: 09:20 [ET]
Event Date: 09/21/2016
Event Time: 02:21 [EDT]
Last Update Date: 09/21/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
PAUL KROHN (R1DO)

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

Event Text

DISCHARGE CHECK VALVE FAILURE TO SEAT CAUSES TRIP OF COMPONENT COOLING WATER PUMP

"At 0221 [EDT] on 9/21/16, Operators at Unit 2 Secured the 21 Component Cooling Water (CCW) Pump for planned maintenance while 22 and 23 CCW pumps were in operation. When the 21 pump was secured, the discharge check valve failed to seat. This resulted in a low system pressure and reverse rotation of the 21 CCW Pump due to the discharge of the 22 and 23 CCW pumps to a common header. When system pressure dropped below 107 psig the 21 CCW pump received an auto start signal. Due to the reverse rotation, the 21 CCW pump tripped on overcurrent. Reactor Operators directed Field Operators to manually shut the 21 CCW Pump discharge valve. The 21 CCW pump Discharge Valve was closed at 0223 [EDT]. This action was successful in stopping the reverse flow and restoring system parameters. During this two minute period the CCW system was declared inoperable and LCO 3.0.3 was entered. Unit 2 exited LCO 3.0.3 at 0223 [EDT] after observing system pressure and flow return to normal. The declaration of inoperability on the CCW system is considered a Loss of Safety Function for purposes of reporting under 50.72(b)(3)(v)(D). There was no reduction in power while in LCO 3.0.3 and no other issues arose."

The Licensee notified the NRC Resident Inspector.

The Licensee notified the Public Service Commission.

Page Last Reviewed/Updated Wednesday, March 24, 2021