Event Notification Report for October 25, 2007

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
10/24/2007 - 10/25/2007

** EVENT NUMBERS **


43731 43733 43734 43739 43742

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General Information or Other Event Number: 43731
Rep Org: LOUISIANA RADIATION PROTECTION DIV
Licensee: CARDINAL HEALTH
Region: 4
City: NEW ORLEANS State: LA
County:
License #: LA-3385-L01
Agreement: Y
Docket:
NRC Notified By: RICHARD PENROD
HQ OPS Officer: STEVE SANDIN
Notification Date: 10/19/2007
Notification Time: 09:55 [ET]
Event Date: 09/24/2007
Event Time: [CDT]
Last Update Date: 10/20/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DAVID PROULX (R4)
CINDY FLANNERY (FSME)

Event Text

AGREEMENT STATE REPORT INVOLVING AN IMPROPER INJECTION

The following information was received from the Louisiana Department of Environmental Quality via fax:

"On September 24, 2007, a customer called the pharmacy to inform them that a Tc-99m mertiatide prescription for renal imaging showed no renal distribution and instead showed only liver distribution. After an investigation by the licensee, it was determined that the error occurred in the pharmacy and all customers who could have been affected by the event were notified. Only one of the patients was injected. The radiation dose to the patient involved was minimal. Procedures not followed is the root cause of this incident. The corrective actions for this incident include retraining on policy and procedures regarding compounding doses.

"Event Report ID No.: LA070028"

* * * UPDATE PROVIDED BY CINDY FLANNERY (FSME) TO JEFF ROTTON AT 1243 ON 10/19/07 * * *

This event (EN43731) has been reviewed and determined to not meet the definition of a medical event.

Notified R4DO (Proulx) and FSME EO (Flannery).

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General Information or Other Event Number: 43733
Rep Org: FLORIDA BUREAU OF RADIATION CONTROL
Licensee: US ARMY CORPS OF ENGINEERS
Region: 1
City: WHITE SPRINGS State: FL
County:
License #: 23-01544-09
Agreement: Y
Docket:
NRC Notified By: JOHN WILLIAMSON
HQ OPS Officer: JOE O'HARA
Notification Date: 10/19/2007
Notification Time: 18:10 [ET]
Event Date: 10/19/2007
Event Time: [EDT]
Last Update Date: 10/19/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RONALD BELLAMY (R1)
ILTAB VIA E-MAIL ()
MICHAEL TSCHILTZ (FSME)

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

POTENTIAL RECOVERY OF LOST OR STOLEN TROXLER MOISTURE DENSITY GAUGE

A local citizen contacted the State of Florida to report that he had a Troxler moisture density gauge Model 3440, S/N 22605 in his possession for a year. The individual stated that he took the gauge from his deceased neighbors home, and that the neighbor had told him he found the gauge in a field.

The state representative was informed by the NRC Operations Center that this device was reported stolen from the U.S. Army Corps of Engineers in FT. Polk, LA in March 2002 and documented on NRC Event Report #38806.

The state is going to retrieve the gauge this evening.

THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks.

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General Information or Other Event Number: 43734
Rep Org: IOWA DEPARTMENT OF PUBLIC HEALTH
Licensee: UNIVERSITY OF IOWA HOSPITAL
Region: 3
City: IOWA CITY State: IA
County:
License #: 0037-1-52-AAB
Agreement: Y
Docket:
NRC Notified By: MELANIE RASMUSSON
HQ OPS Officer: JOE O'HARA
Notification Date: 10/19/2007
Notification Time: 18:43 [ET]
Event Date: 10/19/2007
Event Time: 04:00 [CDT]
Last Update Date: 10/19/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
KENNETH RIEMER (R3)
MICHAEL TSCHILTZ (FSME)

Event Text

AGREEMENT STATE REPORT - PATIENT OVEREXPOSURE GREATER THAN 50 REM

A patient intervened during a vaginal iridium seed implant treatment by removing one of the needles from her body. The needle was found by a nurse approximately 30 minutes after it had been removed by the patient. The needle was located at the foot of the bed near the patients right foot and ankle. The doctor directed the nurse to place the source back into the pig. There were six sources in the needle. Total activity is 7 milliCuries of Ir-192. The estimated dose to the nurses hand was 13 milliRem, and she was wearing a whole body dosimeter, which is being examined. The estimated dose to the patients right ankle is 4.6 to 165 Rem. The patient will be monitored for acute radiation signs. The patient is in the process of receiving the planned dose.

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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General Information or Other Event Number: 43739
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: GEOMAT TESTING LABS., INC.
Region: 4
City: RIVERSIDE State: CA
County:
License #: 5735-33
Agreement: Y
Docket:
NRC Notified By: BARBARA HAMRICK
HQ OPS Officer: JOHN MacKINNON
Notification Date: 10/22/2007
Notification Time: 14:21 [ET]
Event Date: 10/15/2007
Event Time: 17:30 [PDT]
Last Update Date: 10/22/2007
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
CHUCK CAIN (R4)
MICHELE BURGESS (FSME)
ILTAB (EMAIL) ()
MEXICO (EMAILED) ()

This material event contains a "Less than Cat 3" level of radioactive material.

Event Text

CALIFORNIA AGREEMENT STATE REPORT

Received the following information via e-mail:

"On October 22, 2007, a letter, dated 10/17/07, was received from Haytham (deleted), RSO, reporting a stolen nuclear gauge (Troxler 3400 Series, S/N 14411). The incident happened on 10/15/07 at San Bernardino County. According to the incident report, the nuclear gauge was taken to Southwest Calibration in San Bernardino for repair. After the repair, at about 5:30 pm, the field technician stopped at an automobile garage in San Bernardino to have the company truck tail light repaired. The nuclear gauge metal box was bolted close to the tail light access location and was asked by the shop technician to remove the box so they can repair the tail light. The metal box was placed on the side near the waiting room. Then, the technician went inside the waiting room. After the tail light was repaired, the technician went outside and did not find the nuclear gauge.

"The technician called the RSO and left a message. The incident was reported to San Bernardino County Sheriff's Office (Police Report # 030705898) and an ad was placed in the 'SUN', San Bernardino newspaper for seven days.

"RHB - South RAM office will investigate this incident."



5010 Number (Date Notified): 102207

THIS MATERIAL EVENT CONTAINS A "LESS THAN CAT 3" LEVEL OF RADIOACTIVE MATERIAL

Sources that are "Less than IAEA Category 3 sources," are either sources that are very unlikely to cause permanent injury to individuals or contain a very small amount of radioactive material that would not cause any permanent injury. Some of these sources, such as moisture density gauges or thickness gauges that are Category 4, the amount of unshielded radioactive material, if not safely managed or securely protected, could possibly - although it is unlikely - temporarily injure someone who handled it or were otherwise in contact with it, or who were close to it for a period of many weeks.

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Power Reactor Event Number: 43742
Facility: ARKANSAS NUCLEAR
Region: 4 State: AR
Unit: [ ] [2] [ ]
RX Type: [1] B&W-L-LP,[2] CE
NRC Notified By: JOHN HANSON
HQ OPS Officer: PETE SNYDER
Notification Date: 10/24/2007
Notification Time: 00:21 [ET]
Event Date: 10/23/2007
Event Time: 23:05 [CDT]
Last Update Date: 10/24/2007
Emergency Class: ALERT
10 CFR Section:
50.72(a) (1) (i) - EMERGENCY DECLARED
Person (Organization):
CHUCK CAIN (R4)
ELMO COLLINS (R4)
JIM DYER (NRR)
STUART RICHARDS (NRR)
TOM BLOUNT (IRD)
E. HOISINGTON (DHS)
R. TURNER (DOE)
D. TIMMONS (USDA)
F. THREATT (NRC) (EPA)
D. BARDEN (FEMA)

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

ALERT DECLARED DUE TO ELECTRICAL FIRE IN THE AUXILIARY BUILDING

At 2305 an Alert condition was declared based on Emergency Action Level (EAL) 7.6, "Fire or Explosion Onsite Affecting One Train of ESF Systems." The fire was out at the time of the notification. There was no gaseous radiological release.

There were no injuries. The plant continues to operate at full power. The licensee is still assessing the full impact of any damage.

The licensee notified the NRC Resident Inspector.

* * * UPDATE AT 0044 ON 10/24/07 FROM JEFF GERARD TO PETE SNYDER * * *

"Smoke is dissipating." The Alert condition is still in effect. There is no radiological release. There was no explosion.

* * * UPDATE AT 0256 ON 10/24/07 FROM FRED VAN BUSKIRK TO PETE SNYDER * * *

The Alert condition was terminated at 0133 CDT since inspections of the local area confirmed that the fire had been extinguished.

Page Last Reviewed/Updated Thursday, March 25, 2021