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Event Notification Report for July 23, 2002

                         
                    U.S. Nuclear Regulatory Commission
                              Operations Center

                              Event Reports For
                           07/22/2002 - 07/23/2002

                              ** EVENT NUMBERS **

39068  39081  39082  39083  
.
!!!!!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED  !!!!!!!
+------------------------------------------------------------------------------+
|General Information or Other                     |Event Number:   39068       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| REP ORG:  KENTUCKY DEPT OF RADIATION CONTROL   |NOTIFICATION DATE:
07/18/2002|
|LICENSEE:  MONROE COUNTY MEDICAL CENTER         |NOTIFICATION TIME: 11:40[EDT]|
|    CITY:  TOMPKINSVILLE            REGION:  2  |EVENT DATE:        07/12/2002|
|  COUNTY:                            STATE:  KY |EVENT TIME:        16:00[CDT]|
|LICENSE#:  202-247-24            AGREEMENT:  Y  |LAST UPDATE DATE:  07/18/2002|
|  DOCKET:                                       |+----------------------------+
|                                                |PERSON          ORGANIZATION |
|                                                |CHARLIE PAYNE        R2      |
|                                                |FRED BROWN           NMSS    |
+------------------------------------------------+                             |
| NRC NOTIFIED BY:  JOHN A. VOLPE                |                             |
|  HQ OPS OFFICER:  JOHN MacKINNON               |                             |
+------------------------------------------------+                             |
|EMERGENCY CLASS:          NON EMERGENCY         |                             |
|10 CFR SECTION:                                 |                             |
|NAGR                     AGREEMENT STATE        |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
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                                   EVENT TEXT                                   
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| AGREEMENT STATE REPORT INVOLVING A MEDICAL MISADMINISTRATION                 |
|                                                                              |
| "The Technologist (S.H) received a request to perform a Bone Scan on an      |
| impatient.  She selected an MDP Dose (25.1 mCi) and proceeded to the room    |
| listed on requisition.  She approached the patient stated the name.  The     |
| patient acknowledged the name.  The technologist explained  the procedure    |
| and injected the patient.  When the patient presented to the Nuclear         |
| Medicine Department with hospital chart it was discovered that the           |
| misadministration  had occurred.  The technologist notified the authorized   |
| user, the referring physician [and] the Radiation Safety officer.  The       |
| referring physician agreed to notify the patient.  The Technologist was      |
| reinstructed to check the hospital chart for a written order and verify the  |
| patients identity by checking the hospital ORM board."                       |
|                                                                              |
| Used Tc-99m MDP Bone.                                                        |
|                                                                              |
| *****RETRACTED ON 7/18/02 AT 15:27 EDT FROM VOLPE TO LAURA*****              |
|                                                                              |
| The licensee determined the event was NOT reportable since the dose was      |
| below the threshold (greater than 5 REM whole body or greater than 50 REM    |
| for organs) for reportability.                                               |
|                                                                              |
| Notified R2DO (C. PAYNE) and NMSS (F. Brown).                                |
+------------------------------------------------------------------------------+
.
+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   39081       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: COOK                     REGION:  3  |NOTIFICATION DATE: 07/22/2002|
|    UNIT:  [] [2] []                 STATE:  MI |NOTIFICATION TIME: 02:33[EDT]|
|   RXTYPE: [1] W-4-LP,[2] W-4-LP                |EVENT DATE:        07/22/2002|
+------------------------------------------------+EVENT TIME:        00:45[EDT]|
| NRC NOTIFIED BY:  JOHNSON                      |LAST UPDATE DATE:  07/22/2002|
|  HQ OPS OFFICER:  CHAUNCEY GOULD               +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          NON EMERGENCY         |MONTE PHILLIPS       R3      |
|10 CFR SECTION:                                 |                             |
|ARPS 50.72(b)(2)(iv)(B)  RPS ACTUATION - CRITICA|                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE  
|
+-----+----------+-------+--------+-----------------+--------+-----------------+
|                                                   |                          |
|2     A/R        Y       100      Power Operation  |0        Hot Standby      |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| REACTOR AUTOMATICALLY TRIPPED FROM 100% POWER ON REACTOR
TRIP/TURBINE TRIP   |
|                                                                              |
| The reactor trip/turbine trip from 100% power was caused by a loss of main   |
| turbine condenser vacuum that occurred while flushing the condenser          |
| waterboxes.  The cause is unknown and being investigated at this time.   All |
| control rods fully inserted, no ECCS actuated and all emergency and          |
| non-emergency systems functioned as designed.  The main steam stop valves    |
| were manually closed to arrest  RCS cooldown.  RCS temperature was           |
| stabilized using the atmospheric relief valves.                              |
|                                                                              |
| The NRC Resident Inspector was notified,                                     |
+------------------------------------------------------------------------------+
.
+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   39082       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: FITZPATRICK              REGION:  1  |NOTIFICATION DATE: 07/22/2002|
|    UNIT:  [1] [] []                 STATE:  NY |NOTIFICATION TIME: 19:14[EDT]|
|   RXTYPE: [1] GE-4                             |EVENT DATE:        07/22/2002|
+------------------------------------------------+EVENT TIME:        17:10[EDT]|
| NRC NOTIFIED BY:  GENE DORMAN                  |LAST UPDATE DATE:  07/22/2002|
|  HQ OPS OFFICER:  LEIGH TROCINE                +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          NON EMERGENCY         |RICHARD CONTE        R1      |
|10 CFR SECTION:                                 |                             |
|AIND 50.72(b)(3)(v)(D)   ACCIDENT MITIGATION    |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE  
|
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1     N          Y       100      Power Operation  |100      Power Operation  |
|                                                   |                          |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| DISCOVERY OF A HIGH PRESSURE COOLANT INJECTION (HPCI) FLOW CONTROLLER    
   |
| INDICATION OF 500 GPM DURING RESTORATION FROM A CORE SPRAY SYSTEM           
|
| SURVEILLANCE TEST AND WITH THE HPCI SYSTEM IN STANDBY                        |
|                                                                              |
| The following text is a portion of a facsimile received from the licensee:   |
|                                                                              |
| "During restoration from surveillance testing on the 'B' core spray system,  |
| the flow controller for the HPCI system (23FI-108-1) was observed to be      |
| reading 500 gpm with the HPCI system in standby.  The HPCI system was        |
| declared inoperable, and [Technical Specification] 3.5.C.1.b was entered     |
| requiring [either] restoration of 'B' core spray or HPCI to operable status  |
| within 24 hours or [commencement of a unit] shutdown.  'B' core spray was    |
| restored to operability at 1732, and the plant exited [Technical             |
| Specification] 3.5.C.1.b and entered [Technical Specification] 3.5.C.1.a     |
| placing the plant in a [7-day limiting condition for operation (LCO)]."      |
|                                                                              |
| "Since no actuations occurred and [since] no shutdown was initiated, this is |
| only reportable under 10CFR50.72(b)(3) criteria, specifically 10 CFR         |
| 50.72(b)(3)(v)(D).  This is based on the guidance in NUREG 1022, Rev. 2.     |
| Since HPCI is a single train system, even though [technical specifications]  |
| allow a 7-day LCO, declaring HPCI [inoperable] is reportable."               |
|                                                                              |
| "The only unusual/not understood thing associated with this is the flow      |
| indication of 500 gpm.  There were no actuations required so all equipment   |
| functioned and continues to function as expected.  There are no radiological |
| releases associated with this event."                                        |
|                                                                              |
| The licensee plans to notify the NRC resident inspector.                     |
+------------------------------------------------------------------------------+
.
+------------------------------------------------------------------------------+
|Power Reactor                                    |Event Number:   39083       |
+------------------------------------------------------------------------------+
+------------------------------------------------------------------------------+
| FACILITY: MONTICELLO               REGION:  3  |NOTIFICATION DATE: 07/22/2002|
|    UNIT:  [1] [] []                 STATE:  MN |NOTIFICATION TIME: 21:26[EDT]|
|   RXTYPE: [1] GE-3                             |EVENT DATE:        07/22/2002|
+------------------------------------------------+EVENT TIME:        16:30[CDT]|
| NRC NOTIFIED BY:  DUANE BISTODEAU              |LAST UPDATE DATE:  07/22/2002|
|  HQ OPS OFFICER:  LEIGH TROCINE                +-----------------------------+
+------------------------------------------------+PERSON          ORGANIZATION |
|EMERGENCY CLASS:          NON EMERGENCY         |CHRIS MILLER         R3      |
|10 CFR SECTION:                                 |                             |
|AIND 50.72(b)(3)(v)(D)   ACCIDENT MITIGATION    |                             |
|                                                |                             |
|                                                |                             |
|                                                |                             |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR|   INIT RX MODE  |CURR PWR|  CURR RX MODE  
|
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1     N          Y       100      Power Operation  |100      Power Operation  |
|                                                   |                          |
|                                                   |                          |
+------------------------------------------------------------------------------+
                                   EVENT TEXT                                   
+------------------------------------------------------------------------------+
| INOPERABILITY OF BOTH CONTROL ROOM VENTILATION TRAINS                        |
|                                                                              |
| The following text is a portion of a facsimile received from the licensee:   |
|                                                                              |
| "Both control room ventilation (CRV) trains [were] declared inoperable.      |
| While [the] 'B' CRV was inoperable for testing, [the] 'A' CRV chiller        |
| compressor tripped causing [the] 'A' CRV to be inoperable.  [A] 24-hour      |
| [limiting condition for operation (LCO)] was entered per [Technical          |
| Specification] 3.17.A.3.a.  'B' CRV was restored to operable and [the]       |
| 24-hour LCO [was exited] at 1701 [CDT].  [The] 'A' CRV is in a 30-day LCO    |
| per [Technical Specification] 3.17.A.2.a.  [The] 'A' CRV chiller compressor  |
| trip cause [is] unknown."                                                    |
|                                                                              |
| The licensee plans to notify the NRC resident inspector as well as           |
| applicable state and local officials.                                        |
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