Event Notification Report for April 7, 2000
U.S. Nuclear Regulatory Commission
Operations Center
Event Reports For
04/06/2000 - 04/07/2000
** EVENT NUMBERS **
36053 36868 36870 36871
!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!!!
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|Hospital |Event Number: 36053 |
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| REP ORG: UNIVERSITY OF CT HEALTH CENTER |NOTIFICATION DATE: 08/21/1999|
|LICENSEE: UNIVERSITY OF CT HEALTH CENTER |NOTIFICATION TIME: 14:31[EDT]|
| CITY: FARMINGTON REGION: 1 |EVENT DATE: 08/20/1999|
| COUNTY: STATE: CT |EVENT TIME: 17:45[EDT]|
|LICENSE#: 0613022 AGREEMENT: N |LAST UPDATE DATE: 04/06/2000|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |PETER ESELGROTH R1 |
| |JOE HOLONICH NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: KEN PRICE | |
| HQ OPS OFFICER: WILLIAM POERTNER | |
+------------------------------------------------+ |
|EMERGENCY CLASS: N/A | |
|10 CFR SECTION: | |
|LADM 35.33(a) MED MISADMINISTRATION | |
| | |
| | |
| | |
| | |
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EVENT TEXT
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| POSSIBLE MEDICAL MISADMINISTRATION |
| |
| On 8/20/99, a possible medical misadministration occurred at University of |
| CT Health Center located in Farmington, Conn. The physician prescribed a |
| dose of 13 millicuries P-32 (Chromic Phosphate) for a lung cancer patient. |
| After injection, it was determined that only 6.9 millicuries of P-32 had |
| been injected. The physician issued a revised written directive for 7 |
| millicuries of P-32 based on the patients condition. |
| |
| (Call the NRC Operations Center for a licensee contact telephone number.) |
| |
| * * * RETRACTION REPORTED BY KEN PRICE ON 04/06/00 AT 1622 EDT TAKEN BY |
| MACKINNON * * * |
| |
| The licensee is retracting this event after discussions with NRC Region 1 |
| (David Dwyer). The Physician changed the written directive for the amount |
| of dose that the patient was to have received. Therefore, this event is not |
| reportable and is being retracted. NRC R1DO (Jack McFadden) and NMSS EO |
| (John Hickey) notified. |
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|Other Nuclear Material |Event Number: 36868 |
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| REP ORG: U.S. NAVY |NOTIFICATION DATE: 04/05/2000|
|LICENSEE: U.S. NAVY |NOTIFICATION TIME: 13:00[EDT]|
| CITY: YUMA REGION: 4 |EVENT DATE: 04/04/2000|
| COUNTY: STATE: AZ |EVENT TIME: 15:30[MST]|
|LICENSE#: 45-23645-01NA AGREEMENT: Y |LAST UPDATE DATE: 04/06/2000|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |BILL JONES R4 |
| |STEVE CAHILL R2 |
+------------------------------------------------+SCOTT MOORE NMSS |
| NRC NOTIFIED BY: CDR. GARY HIGGINS | |
| HQ OPS OFFICER: FANGIE JONES | |
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|EMERGENCY CLASS: N/A | |
|10 CFR SECTION: | |
|BAB1 20.2201(a)(1)(i) LOST/STOLEN LNM>1000X | |
| | |
| | |
| | |
| | |
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EVENT TEXT
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| STRONTIUM/YTTRIUM SOURCE LOST TO LANDFILL |
| |
| A generally licensed strontium/yttrium source, 500 mCi, from an 'In Flight |
| Blade Inspection System' was improperly placed in a dumpster which in turn |
| was dumped at a regular land fill. The U.S. Navy is investigating the |
| incident and trying to determine where and how deep the source is in the |
| land fill. |
| |
| The U.S. Navy notified NRC Region 2 (M. Fuller) and intends to notify the |
| State of Arizona. |
| |
| ****************** UPDATE AT 0814 ON 04/06/00 FROM GARY HIGGINS TO LEIGH |
| TROCINE ****************** |
| |
| The licensee called to provide the following correction to the original |
| report: |
| |
| The licensee reported that they were provided with an incorrect activity for |
| the missing source. They were originally informed that the activity was 500 |
| mCi when in fact the actual activity was 500 �Ci. |
| |
| The licensee notified the NRC Region 2 office (Mike Fuller). The NRC |
| operations officer notified the R2DO (Cahill), R4DO (Jones), and NMSS EO |
| (Sturz). |
| |
| (Call the NRC operations officer for a licensee contact telephone number.) |
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|Power Reactor |Event Number: 36870 |
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| FACILITY: HATCH REGION: 2 |NOTIFICATION DATE: 04/06/2000|
| UNIT: [] [2] [] STATE: GA |NOTIFICATION TIME: 12:38[EDT]|
| RXTYPE: [1] GE-4,[2] GE-4 |EVENT DATE: 04/06/2000|
+------------------------------------------------+EVENT TIME: 10:00[EDT]|
| NRC NOTIFIED BY: BARRY COLEMAN |LAST UPDATE DATE: 04/06/2000|
| HQ OPS OFFICER: JOHN MacKINNON +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: N/A |STEVE CAHILL R2 |
|10 CFR SECTION: | |
|AESF 50.72(b)(2)(ii) ESF ACTUATION | |
| | |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
| | |
|2 N N 0 Cold Shutdown |0 Cold Shutdown |
| | |
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EVENT TEXT
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| GROUP 1 ISOLATION OCCURRED DURING MAIN TURBINE CONTROL TESTING WHICH CAUSED |
| THE REACTOR COOLANT SAMPLE VALVES TO CLOSE. |
| |
| During performance of Main Turbine Control testing, a Group 1 isolation |
| occurred which caused Reactor Coolant sample valves 2B31 F019 & F020 (0.75" |
| line; 1.0" valves) to close. One of the jumpers installed during the Main |
| Turbine Control test made the Main Turbine Logic think that the generator |
| was tied to the line. This caused the Main Turbine speed control to go to |
| 1800 RPM because the main turbine speed control was selected to 1800 RPM |
| instead of all valves closed. When the operator reset the Main Turbine, |
| all 4 Main Turbine Stop Valves opened as a result of the speed control being |
| selected to 1800 RPM. A Group 1 isolation occurred due to the Main Turbine |
| stop valves opening coincident with a low Main Condenser Vacuum. Only the |
| Reactor Coolant Sample Valves closed. Main Steam Isolation valves and the |
| Main Steam line drain valves remained closed during the Group 1 isolation. |
| The licensee is continuing the Main Turbine Control Test. |
| |
| |
| The NRC Resident Inspector was notified of the event by the licensee. |
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|Power Reactor |Event Number: 36871 |
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| FACILITY: INDIAN POINT REGION: 1 |NOTIFICATION DATE: 04/06/2000|
| UNIT: [2] [] [] STATE: NY |NOTIFICATION TIME: 14:02[EDT]|
| RXTYPE: [2] W-4-LP,[3] W-4-LP |EVENT DATE: 04/06/2000|
+------------------------------------------------+EVENT TIME: 12:05[EDT]|
| NRC NOTIFIED BY: JOHN LAMB |LAST UPDATE DATE: 04/06/2000|
| HQ OPS OFFICER: JOHN MacKINNON +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: N/A |JACK MCFADDEN R1 |
|10 CFR SECTION: | |
|ADAS 50.72(b)(2)(i) DEG/UNANALYZED COND | |
| | |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|2 N N 0 Cold Shutdown |0 Cold Shutdown |
| | |
| | |
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EVENT TEXT
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| SPENT FUEL POOL STORAGE RACKS BORAFLEX DEGRADING. |
| |
| |
| An evaluation of a preliminary report on the Spent Fuel Pool storage racks |
| Boraflex testing determined that degradation is occurring. Some racks might |
| not be able to receive fuel and ensure the Technical Specification |
| requirement of maintaining Keff <= to 0.95 with un-borated water could be |
| assured. Administrative controls will ensure that Keff is maintained <= to |
| 0.95. The design of the fuel racks was to allow full core off-loads for the |
| term of the license. |
| |
| |
| The NRC Resident Inspector was notified of this event by the licensee. |
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Page Last Reviewed/Updated Thursday, March 25, 2021