Event Notification Report for July 05, 2011
U.S. Nuclear Regulatory Commission
Operations Center
EVENT REPORTS FOR
07/04/2011 - 07/05/2011
Power Reactor
Event Number: 47026
Facility: CRYSTAL RIVER
Region: 2 State: FL
Unit: [3] [] []
RX Type: [3] B&W-L-LP
NRC Notified By: DAVID MC AGY
HQ OPS Officer: PETE SNYDER
Region: 2 State: FL
Unit: [3] [] []
RX Type: [3] B&W-L-LP
NRC Notified By: DAVID MC AGY
HQ OPS Officer: PETE SNYDER
Notification Date: 07/06/2011
Notification Time: 09:10 [ET]
Event Date: 07/05/2011
Event Time: 17:14 [EDT]
Last Update Date: 07/06/2011
Notification Time: 09:10 [ET]
Event Date: 07/05/2011
Event Time: 17:14 [EDT]
Last Update Date: 07/06/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
26.719 - FITNESS FOR DUTY
10 CFR Section:
26.719 - FITNESS FOR DUTY
Person (Organization):
BRIAN BONSER (R2DO)
BRIAN BONSER (R2DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 3 | N | N | 0 | Refueling | 0 | Refueling |
SUPERVISORY EMPLOYEE TESTED POSITIVE FOR ALCOHOL
A non-licensed employee supervisor had a confirmed positive for alcohol during a for-cause fitness-for-duty test. The employee's unescorted access has been terminated. Contact the NRC Headquarters Operations Officer for additional details.
The plant is currently defueled and not in refueling mode.
The licensee notified the NRC Resident Inspector.
A non-licensed employee supervisor had a confirmed positive for alcohol during a for-cause fitness-for-duty test. The employee's unescorted access has been terminated. Contact the NRC Headquarters Operations Officer for additional details.
The plant is currently defueled and not in refueling mode.
The licensee notified the NRC Resident Inspector.
Power Reactor
Event Number: 47024
Facility: PERRY
Region: 3 State: OH
Unit: [1] [] []
RX Type: [1] GE-6
NRC Notified By: GLENDON BURNHAM
HQ OPS Officer: CHARLES TEAL
Region: 3 State: OH
Unit: [1] [] []
RX Type: [1] GE-6
NRC Notified By: GLENDON BURNHAM
HQ OPS Officer: CHARLES TEAL
Notification Date: 07/05/2011
Notification Time: 20:35 [ET]
Event Date: 07/05/2011
Event Time: 18:15 [EDT]
Last Update Date: 07/05/2011
Notification Time: 20:35 [ET]
Event Date: 07/05/2011
Event Time: 18:15 [EDT]
Last Update Date: 07/05/2011
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
DAVID HILLS (R3DO)
DAVID HILLS (R3DO)
| Unit | SCRAM Code | RX Crit | Initial PWR | Initial RX Mode | Current PWR | Current RX Mode |
|---|---|---|---|---|---|---|
| 1 | N | Y | 100 | Power Operation | 100 | Power Operation |
TWO APPENDIX R WIRING ISSUES THAT COULD POTENTIALLY AFFECT THE ABILITY TO SHUTDOWN
"On July 5, 2011, at 1815 hours, it was determined that a design deficiency at the Perry Nuclear Power Plant (PNPP) constituted a fire protection program concern which could adversely affect the ability to achieve and maintain safe shutdown of the plant in the event of a control room fire. (Reference event notification numbers 46811 and 46997). In the event of a postulated control room fire, the potential exists that two 4160 VAC breakers could trip open under a hot-short condition.
"PNPP's Appendix R design vulnerability only affects Breakers EH1106, which supplies the Emergency Service Water Pump A and EH1107, which supplies the Control Complex Chiller A. Specifically, the current transformers used in these breakers for the 50/51 instantaneous and time over current protective relays are in line with the component control room ammeters. Therefore, a hot-short-to-ground in the associated control room ammeters could actuate the 50/51 relays and trip the component breaker.
"Actions are in progress to isolate the control room ammeters for the Emergency Service Water Pump A in breaker EH1106 and the Control Complex Chiller A in breaker EH1107. Isolating these ammeters would isolate the affected circuitry from the described Appendix R failure mechanism. Control room amperage indication for the pump and chiller would be lost while this Temporary Modification is installed. PNPP will pursue a permanent resolution to the hot-short-to-ground fault for the EH1106 and EH1107 breakers.
"This event is being reported in accordance with 10 CFR 50.72(b)(3)(ii)(B), as a condition that results in the nuclear power plant being in an unanalyzed condition that significantly degrades plant safety. A follow-up licensee event report will be made in 60 days. The resident inspector has been notified."
"On July 5, 2011, at 1815 hours, it was determined that a design deficiency at the Perry Nuclear Power Plant (PNPP) constituted a fire protection program concern which could adversely affect the ability to achieve and maintain safe shutdown of the plant in the event of a control room fire. (Reference event notification numbers 46811 and 46997). In the event of a postulated control room fire, the potential exists that two 4160 VAC breakers could trip open under a hot-short condition.
"PNPP's Appendix R design vulnerability only affects Breakers EH1106, which supplies the Emergency Service Water Pump A and EH1107, which supplies the Control Complex Chiller A. Specifically, the current transformers used in these breakers for the 50/51 instantaneous and time over current protective relays are in line with the component control room ammeters. Therefore, a hot-short-to-ground in the associated control room ammeters could actuate the 50/51 relays and trip the component breaker.
"Actions are in progress to isolate the control room ammeters for the Emergency Service Water Pump A in breaker EH1106 and the Control Complex Chiller A in breaker EH1107. Isolating these ammeters would isolate the affected circuitry from the described Appendix R failure mechanism. Control room amperage indication for the pump and chiller would be lost while this Temporary Modification is installed. PNPP will pursue a permanent resolution to the hot-short-to-ground fault for the EH1106 and EH1107 breakers.
"This event is being reported in accordance with 10 CFR 50.72(b)(3)(ii)(B), as a condition that results in the nuclear power plant being in an unanalyzed condition that significantly degrades plant safety. A follow-up licensee event report will be made in 60 days. The resident inspector has been notified."
!!!!! THIS EVENT HAS BEEN RETRACTED !!!!!
!!!!! THIS EVENT HAS BEEN RETRACTED !!!!!
Non-Agreement State
Event Number: 47722
Rep Org: INDIANA UNIVERSITY MEDICAL CENTER
Licensee: INDIANA UNIVERSITY MEDICAL CENTER
Region: 3
City: INDIANAPOLIS State: IN
County:
License #: 13-02752-03
Agreement: N
Docket:
NRC Notified By: MACK RICHARD
HQ OPS Officer: JOHN KNOKE
Licensee: INDIANA UNIVERSITY MEDICAL CENTER
Region: 3
City: INDIANAPOLIS State: IN
County:
License #: 13-02752-03
Agreement: N
Docket:
NRC Notified By: MACK RICHARD
HQ OPS Officer: JOHN KNOKE
Notification Date: 03/07/2012
Notification Time: 14:45 [ET]
Event Date: 07/05/2011
Event Time: 00:00 [EST]
Last Update Date: 04/19/2012
Notification Time: 14:45 [ET]
Event Date: 07/05/2011
Event Time: 00:00 [EST]
Last Update Date: 04/19/2012
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
MARK RING (R3DO)
ANGELA MCINTOSH (FSME)
MARK RING (R3DO)
ANGELA MCINTOSH (FSME)
MEDICAL EVENT - DOSAGE DELIVERED TO PATIENT DIFFERED BY 20% FROM PRESCRIBED DOSAGE
On 7/5/11 a male patient receiving treatment for prostate cancer was supposed to receive 52 Iodine-125 seeds to the prostate. The physician conducting the surgery injected 21 of the 52 seeds to an area outside the target volume. Only 31 of the 52 seeds were injected into the targeted area.
The physician and patient will be advised of the disparity in dosage.
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.
* * * RETRACTION AT 1100 EST ON 4/19/12 FROM RICHARD TO SIMPSON * * *
The licensee is retracting this event report after a review and evaluation of the doses administered. The licensee has determined that this event is not reportable based on the delivered dose not differing by 20% from the prescribed dosage and is therefore not reportable under 10 CFR 35.3045.
The licensee has discussed this conclusion with NRC Region 3 (Warren).
R3DO (Peterson) and FSME (McIntosh) have been notified.
On 7/5/11 a male patient receiving treatment for prostate cancer was supposed to receive 52 Iodine-125 seeds to the prostate. The physician conducting the surgery injected 21 of the 52 seeds to an area outside the target volume. Only 31 of the 52 seeds were injected into the targeted area.
The physician and patient will be advised of the disparity in dosage.
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.
* * * RETRACTION AT 1100 EST ON 4/19/12 FROM RICHARD TO SIMPSON * * *
The licensee is retracting this event report after a review and evaluation of the doses administered. The licensee has determined that this event is not reportable based on the delivered dose not differing by 20% from the prescribed dosage and is therefore not reportable under 10 CFR 35.3045.
The licensee has discussed this conclusion with NRC Region 3 (Warren).
R3DO (Peterson) and FSME (McIntosh) have been notified.