Alert

Due to a lapse in appropriations, the NRC has ceased normal operations. However, excepted and exempted activities necessary to maintain critical health and safety functions—as well as essential progress on designated critical activities, including those specified in Executive Order 14300—will continue, consistent with the OMB-Approved NRC Lapse Plan.

Event Notification Report for September 7, 2004

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
09/06/2004 - 09/07/2004

** EVENT NUMBERS **

41008

41023

General Information or Other	Event Number: 41008
Rep Org: WISCONSIN RADIATION PROTECTION Licensee: AURORA BAYCARE MEDICAL CENTER Region: 3 City: AURORA State: WI County: License #: 09-1017-01 Agreement: Y Docket: NRC Notified By: PAUL CALEB HQ OPS Officer: JOHN MacKINNON	Notification Date: 09/02/2004 Notification Time: 11:20 [ET] Event Date: 08/31/2004 Event Time: 14:00 [CDT] Last Update Date: 09/02/2004
Emergency Class: NON EMERGENCY 10 CFR Section: AGREEMENT STATE	Person (Organization): JULIO LARA (R3) LINDA GERSEY (NMSS)

Event Text

WISCONSIN AGREEMENT STATE REPORT: SOURCE FAILED TO RETRACT

"On the evening of August 31, 2004 during a mammosite treatment utilizing a Varian HDR unit, the source failed to retract upon completion of the treatment time. The licensee's RSO/AMP had to enter the treatment room and retract the source manually.

"The licensee subsequently contacted Varian for assistance. A service representative from Varian arrived at Aurora Baycare Medical Center on Wednesday, Sept. 1, 2004. The Varian service representative found nothing wrong with the HDR unit. However, approximately 2 cm of the connecting catheter had 'buckled' (appeared melted and twisted), possibly restricting source movement. The licensee has contacted the catheter manufacturer for assistance in analyzing the catheter to determine what may have caused it to buckle.

"Preliminary dose indications by the licensee indicate that the patient received an additional amount of dose to the skin while the source was being retracted. The licensee reported that the most probable estimate of the additional skin dose is 1.0 Gy."

Power Reactor	Event Number: 41023
Facility: CRYSTAL RIVER Region: 2 State: FL Unit: [3] [ ] [ ] RX Type: [3] B&W-L-LP NRC Notified By: R. SWEENEY HQ OPS Officer: STEVE SANDIN	Notification Date: 09/06/2004 Notification Time: 12:44 [ET] Event Date: 09/06/2004 Event Time: 11:50 [EDT] Last Update Date: 09/06/2004
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): BENOIT DESAI (R2) MICHAEL CASE (NRR) RICHARD WESSMAN (IRD)

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

Event Text

AUTOMATIC REACTOR TRIP FOLLOWING PARTIAL LOSS OF OFFSITE POWER

"At approximately 1150 [EDT], CR3 Site experienced a 230KV 'B' Buss loss. The resultant loss of power was a loss of both non-vital 4160V busses. All RCPs tripped and a reactor trip occurred. The plant is stable on natural circulation cooling.

"This report is based on the Reactor Protection System Actuation and Specified System Actuation (Emergency Feedwater)."

The "B" ESF 4160KV Bus deenergized resulting in an autostart of the "B" EDG, as expected. Natural Circulation has been confirmed with both Steam Generators [SGs] receiving Emergency Feedwater [EFW] via both the Turbine-Driven and Diesel-Driven EFW Pumps. The SGs are using the Atmospheric Dumps to remove decay heat. There was no known SG tube leakage prior to the transient. The cause for the partial loss of offsite power is under investigation.

The licensee informed the NRC Resident Inspector.

Page Last Reviewed/Updated Thursday, March 25, 2021