United States Nuclear Regulatory Commission - Protecting People and the Environment
Home > NRC Library > Document Collections > Reports Associated with Events > Event Notification Reports > 2009 > June 18

Event Notification Report for June 18, 2009

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
06/17/2009 - 06/18/2009

** EVENT NUMBERS **


45125 45126 45136 45137 45138

To top of page
General Information or Other Event Number: 45125
Rep Org: PA BUREAU OF RADIATION PROTECTION
Licensee: MERCY FITZGERALD HOSPITAL
Region: 1
City: DARBY State: PA
County:
License #: PA-0082
Agreement: Y
Docket:
NRC Notified By: DAVID J. ALLARD
HQ OPS Officer: STEVE SANDIN
Notification Date: 06/11/2009
Notification Time: 21:00 [ET]
Event Date: 03/26/2009
Event Time: [EDT]
Last Update Date: 06/11/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RONALD BELLAMY (R1DO)
ANDREA KOCK (FSME)

Event Text

AGREEMENT STATE REPORT - MEDICAL EVENT INVOLVING AN UNDERDOSE DUE TO TECHNICIAN ERROR

The following information was received via fax:

"Event Report ID No: PA090015

"License No: PA-0082

"Licensee: Mercy Fitzgerald Hospital

"Event date and time: March 26, 2009/time unknown

"Event location: Mercy Fitzgerald Hospital Lansdowne & Baily Rds., Darby, PA

"Event type: Medical Event

"Notifications: A letter dated April 9, 2009 was sent to DEP

"Event description: Under dose for a Sr-90 eye applicator

"City, State: Darby, PA

"Description: PA DEP Bureau of Radiation Protection was notified in writing, dated April 9, 2009, by the Radiation Safety Officer for Mercy Fitzgerald Hospital. An ADCL calibrated Sr-90 ophthalmic applicator was used on a patient for an external eye application for the treatment of pterygium. The guard ring needed to be removed before treatment and was not, hence only delivered 5% of the prescribed dose to the patient.

"The State has an inspection scheduled and will continue to keep NRC informed of the status of our investigation."

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.

To top of page
General Information or Other Event Number: 45126
Rep Org: LOUISIANA DEQ
Licensee: H & S CONSTRUCTION COMPANY
Region: 4
City:  State: LA
County: IBERIA PARISH
License #: LA-7721-L01A
Agreement: Y
Docket:
NRC Notified By: ANN TROXLER
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 06/12/2009
Notification Time: 11:04 [ET]
Event Date: 05/29/2009
Event Time: [CDT]
Last Update Date: 06/12/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
GEOFFREY MILLER (R4DO)
ANGELA MCINTOSH (FSME)

Event Text

AGREEMENT STATE REPORT - DAMAGED MOISTURE DENSITY GAUGE

The following report was received via facsimile:

"On May 29, 2009, H & S Construction reported that a Troxler moisture density gauge was accidently backed into. The gauge was a Troxler model 3440, serial number 28470, with a 9 mCi source of Cs-137 and a 44 mCi source of Am:Be. The source was in the locked and shielded position when it was hit. The plastic cover on the gauge was broken on one side. An investigation was performed by DEQ [Department of Environmental Quality]. A radiation survey was performed with readings of 7 mR/hr on the damaged side and 3 mR/hr on the undamaged side. The gauge was taken to Gamma-Tron Services so a leak test could be performed. The leak test (less than 0.005 uCi of removable contamination) confirmed that neither the Cs-137 source nor the Am:Be source were damaged or compromised during this incident.

Louisiana Report: LA090013

To top of page
Power Reactor Event Number: 45136
Facility: KEWAUNEE
Region: 3 State: WI
Unit: [1] [ ] [ ]
RX Type: [1] W-2-LP
NRC Notified By: GARY AHRENS
HQ OPS Officer: BILL HUFFMAN
Notification Date: 06/17/2009
Notification Time: 11:46 [ET]
Event Date: 06/17/2009
Event Time: 08:25 [CDT]
Last Update Date: 06/17/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(2)(xi) - OFFSITE NOTIFICATION
Person (Organization):
CHRISTINE LIPA (R3DO)
ENDANGERED SPECIES (EMAI)

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

Event Text

OFFSITE NOTIFICATION TO FISH AND WILDLIFE AGENT

"On 06/17/2009 at 0825 CDT, Kewaunee Power Station notified US Fish and Wildlife Agent that a Peregrine Falcon died onsite. Kewaunee Power Station (KPS) had a breeding pair of Peregrine Falcons nesting on top of the Containment structure with four fledglings. On 6/16/09, one of the fledglings landed on the ground under the nest.

"The fledgling was found dead from natural causes when checked the morning of 6/17/09. The local US Fish and Wildlife Agent was notified by phone message and e-mail at 0825 hrs on 6/17/09. The carcass will be stored frozen at KPS until it is delivered to the local USFWS Agent per USFWS request.

"This is being conservatively reported under 10 CFR 50.72(b)(2)(xi),'Offsite Notification'. The licensee has notified the NRC Resident Inspector."

To top of page
Hospital Event Number: 45137
Rep Org: RAPID CITY REGIONAL HOSPITAL
Licensee: RAPID CITY REGIONAL HOSPITAL
Region: 4
City: RAPID CITY State: SD
County:
License #: 40-00238-04
Agreement: N
Docket:
NRC Notified By: LOWELL HUSMAN
HQ OPS Officer: STEVE SANDIN
Notification Date: 06/17/2009
Notification Time: 11:48 [ET]
Event Date: 04/24/2009
Event Time: 14:00 [MDT]
Last Update Date: 06/17/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3047(a) - EMBRYO/FETUS DOSE > 50 mSv
Person (Organization):
CHUCK CAIN (R4DO)
ANGELA MCINTOSH (FSME)

Event Text

REPORT INVOLVING THERAPEUTIC ADMINISTRATION OF I-131 TO PATIENT IN EARLY PREGNANCY

On 4/24/09 at approximately 1400 hours, a female patient undergoing treatment for hyperthyroidism received a 12.1 millicuries dose of I-131. She had completed both a questionnaire and lab test indicating that she was not pregnant prior to receiving treatment. Subsequent to the administration, she learned she had conceived approximately 2-3 days prior to treatment. This information was provided to hospital staff on 6/16 at which time an evaluation for potential adverse consequences was initiated.

The licensee discussed this issue with NRC Region IV staff (Leonardi).

To top of page
Power Reactor Event Number: 45138
Facility: SAN ONOFRE
Region: 4 State: CA
Unit: [ ] [2] [3]
RX Type: [1] W-3-LP,[2] CE,[3] CE
NRC Notified By: SUSAN GARDNER
HQ OPS Officer: BILL HUFFMAN
Notification Date: 06/17/2009
Notification Time: 17:10 [ET]
Event Date: 06/17/2009
Event Time: 08:56 [PDT]
Last Update Date: 06/17/2009
Emergency Class: NON EMERGENCY
10 CFR Section:
26.719 - FITNESS FOR DUTY
Person (Organization):
CHUCK CAIN (R4DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N Y 99 Power Operation 99 Power Operation
3 N Y 100 Power Operation 100 Power Operation

Event Text

FITNESS FOR DUTY INVOLVING A NON-LICENSED SUPERVISOR

A non-licensed employee supervisor had a confirmed positive for alcohol during a random fitness-for-duty test. The employee's access to the plant has been revoked. Contact the Headquarters Operations Officer for additional details.

The licensee notified the NRC Resident Inspector.

Page Last Reviewed/Updated Thursday, March 29, 2012
Thursday, March 29, 2012