United States Nuclear Regulatory Commission - Protecting People and the Environment
Home > NRC Library > Document Collections > Reports Associated with Events > Event Notification Reports > 2016 > February 18

Event Notification Report for February 18, 2016

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
02/17/2016 - 02/18/2016

** EVENT NUMBERS **


51709 51718 51719 51739 51741

To top of page
Agreement State Event Number: 51709
Rep Org: WA OFFICE OF RADIATION PROTECTION
Licensee: ISORAY
Region: 4
City: RICHLAND State: WA
County:
License #: WN-L0213-1
Agreement: Y
Docket:
NRC Notified By: ANINE GRUMBLES
HQ OPS Officer: JEFF HERRERA
Notification Date: 02/04/2016
Notification Time: 16:47 [ET]
Event Date: 02/04/2016
Event Time: [PST]
Last Update Date: 02/17/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
GREG PICK (R4DO)
NMSS_EVENTS_NOTIFIC (EMAI)
CNSC (CANADA) (FAX)

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

Event Text

AGREEMENT STATE - LOST SHIPMENT OF CS-131 BRACHYTHERAPY SEEDS

The following report was received from the Washington Department of Health, Office of Radiation Protection via email:

"[On] 2/4/16, [a common carrier] has lost track of a RAM [radioactive material] Cs-131 brachytherapy seed shipment sent for a patient near Atlanta, GA. The seeds did not reach their destination in time for the implant in a patient at a clinic approximately 1 to 1.5 hrs from Atlanta, so the customer alerted IsoRay. According to IsoRay's Radiation Safety Officer, [the common carrier] is looking for the package. [The common carrier] thinks there is a possibility that the shipment may have been mistakenly transferred from the [common carriers] plane to the US Postal Service at the air field in Atlanta. IsoRay's Radiation Safety Officer called Washington State at [approximately] 9:40 AM [EST] to report the loss. Additional information is forthcoming."

Washington Incident Number: WA-16-004

* * * UPDATE FROM ANINE GRUMBLES TO DANIEL MILLS AT 1750 EST ON 2/08/2016 * * *

The following was received from Washington via email:

"Quantity of seeds in order: 48
"Air kerma strength in micrograys per sq. meter/hr (U) - 2.02 - 2.08 = total 98 U
"Total apparent activity= 154 mCi (range from 3.17 - 3.26 mCi/seed)
"T1/2 = 9.69 days [half-life]"

Notified R4DO (O'Keefe), NMSS_EVENTS_NOTIFICATION (email), and CNSC Canada (email).

* * * UPDATE FROM ANINE GRUMBLES TO DANIEL MILLS AT 1640 EST ON 2/17/2016 * * *

The following was received from Washington via email:

"According to the Radiation Safety Officer at the seed manufacturer/distributor, IsoRay, the US Postal Service delivered the lost package to the intended user at the end of last week. The source had decayed to the point of being useless. The customer is going to send shipment back IsoRay.'"

Notified R4DO (Vasquez), NMSS_EVENTS_NOTIFICATION (email), and CNSC Canada (email).

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. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

To top of page
Agreement State Event Number: 51718
Rep Org: WA OFFICE OF RADIATION PROTECTION
Licensee: WASHINGTON STATE UNIVERSITY
Region: 4
City: PULLMAN State: WA
County:
License #: WN-C003-1
Agreement: Y
Docket:
NRC Notified By: ANINE GRUMBLES
HQ OPS Officer: JEFF ROTTON
Notification Date: 02/09/2016
Notification Time: 11:47 [ET]
Event Date: 02/04/2016
Event Time: [PST]
Last Update Date: 02/09/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
NEIL OKEEFE (R4DO)
NMSS_EVENTS_NOTIFIC (EMAI)

Event Text

AGREEMENT STATE REPORT - LEAKING NI-63 SEALED SOURCE

The following information was provided by the State of Washington via email:

"Radiation Safety staff at WSU [Washington State University] discovered a GC ECD [Gas Chromatography - Electron Capture Detector] to be leaking during the semi annual sealed source leak test. The sealed source leak test revealed 0.00686 microCuries of removable contamination. The source was removed from the laboratory where it was stored in a box and immediately transferred to radioactive waste, pending disposal. The ECD had been stored in a box and had not been used for several years. Both the source location and the GC were surveyed to ensure contamination was not present. Survey results were well below regulatory limits."

The source manufacturer/model number: Hewlett Packard model 5890A, serial number M2044. The sealed source contains 0.015 Ci of Ni-63.

WA Incident Number: WA-16-005

To top of page
Agreement State Event Number: 51719
Rep Org: PA DEPT OF ENV PROTECTION
Licensee: CROZER CHESTER MED CTR
Region: 1
City: UPLAND State: PA
County:
License #: PA-0061
Agreement: Y
Docket:
NRC Notified By: JOSEPH MELNIC
HQ OPS Officer: DANIEL MILLS
Notification Date: 02/09/2016
Notification Time: 12:21 [ET]
Event Date: 02/03/2016
Event Time: 13:00 [EST]
Last Update Date: 02/09/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RAY POWELL (R1DO)
NMSS_EVENTS_NOTIFIC (EMAI)
ANGELA MCINTOSH (NMSS)

Event Text

AGREEMENT STATE REPORT - UNPLANNED CONTAMINATION

The following was received from Pennsylvania via fax:

"The licensee discovered the event on February 4, 2016, and notified the Department [PA Dept of Environmental Protection] after normal business hours on Friday, February 5, 2016. It is reportable per 10 CFR 30.50(b)(1)(i).

"A 30 year old female patient was treated with 61.4 milliCuries of Iodine-131(I-131) for thyroid cancer and released, with proper discharge instructions, at noon on 02/03/16. The patient then returned to the emergency room (ER) at the same location at [1300 EST]. The patient did not disclose the previous I-131 treatment to ER staff until later that evening. The ER staff immediately contacted radiation safety personnel at 0100 on 02/04/16. The patient was then segregated and all access to the original room was controlled and posted properly. Surveys were taken and all linens and other potentially contaminated materials were collected for proper storage and decay. A radiation survey performed at 0930 on 02/04/16 estimated the potential maximum radiation exposure to staff to be 3 millirem.

"Patient failed to follow the discharge instructions given.

"A reactive inspection is planned by the Department. More information will be provided upon receipt."

Pennsylvania Event Report ID #: PA160006

To top of page
Power Reactor Event Number: 51739
Facility: BRUNSWICK
Region: 2 State: NC
Unit: [1] [2] [ ]
RX Type: [1] GE-4,[2] GE-4
NRC Notified By: MARK TURKAL
HQ OPS Officer: JEFF ROTTON
Notification Date: 02/17/2016
Notification Time: 10:36 [ET]
Event Date: 01/09/2016
Event Time: 09:46 [EST]
Last Update Date: 02/17/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
50.73(a)(1) - INVALID SPECIF SYSTEM ACTUATION
Person (Organization):
SHANE SANDAL (R2DO)

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

Event Text

INVALID ACTUATION OF EMERGENCY DIESEL GENERATOR

"This 60-day optional telephone notification is being made in lieu of an LER submittal, as allowed by 10 CFR 50.73(a)(1). This notification is made pursuant to the reporting requirements specified in 10 CFR 50.73(a)(2)(iv)(A) for an invalid actuation of one of the systems listed in 10 CFR 50.73(a)(2)(iv)(B).

"On January 9, 2016, at 0946 Eastern Standard Time (EST), an invalid actuation of EDG 2 occurred. During the performance of procedure 0PT-12.2.1B, 'ECCS D/G #2 Logic Test,' procedure steps were performed out of sequence. As a result, the EDG 2 control logic was not properly defeated to prevent the auto-start prior to testing portions of the Emergency Core Cooling System (ECCS) EDG 2 logic.

"EDG 2 responded properly to the auto-start signal. The actuation was complete, in that the EDG started and ran unloaded. EDG 2 was returned to standby status at 1130 EST. Since no actual bus under voltage condition existed which required the EDG to start, and the start was not in response to actual plant conditions satisfying the requirements for initiation, this event has been classified as an invalid actuation.

"This event did not result in any adverse impact to the health and safety of the public."

The licensee has notified the NRC Resident Inspector.

To top of page
Power Reactor Event Number: 51741
Facility: LASALLE
Region: 3 State: IL
Unit: [ ] [2] [ ]
RX Type: [1] GE-5,[2] GE-5
NRC Notified By: MARK SMITH
HQ OPS Officer: DANIEL MILLS
Notification Date: 02/17/2016
Notification Time: 17:05 [ET]
Event Date: 02/17/2016
Event Time: 10:35 [CST]
Last Update Date: 02/17/2016
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(v)(C) - POT UNCNTRL RAD REL
50.72(b)(3)(v)(D) - ACCIDENT MITIGATION
Person (Organization):
ROBERT ORLIKOWSKI (R3DO)

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

SECONDARY CONTAINMENT INOPERABLE DUE TO DOOR INTERLOCK MALFUNCTION

"This report is being made pursuant to 10 CFR 50.72(b)(3)(v)(C), event or condition that could have prevented fulfillment of a safety function needed to control the release of radioactive material and 10 CFR 50.72(b)(3)(v)(D), an event or condition that could have prevented fulfillment of a safety function needed to mitigate the consequences of an accident. An employee entered a secondary containment interlock and identified that both doors of the interlock opened simultaneously when the door on the reactor building side was opened. The employee immediately secured both doors in the interlock and notified the Main Control Room Supervisor. Both doors in the interlock were open for approximately 5 seconds. With both doors open, TS SR 3.6.4.1.2 was not met. This rendered secondary containment inoperable per TS 3.6.4.1. Reactor Building differential pressure, as observed in the Main Control Room, has remained less than -0.25 inches H20 at all times. Initial investigation determined that a mechanical interlock for the doors was malfunctioning. Administrative controls have been put in place to ensure the doors remain closed pending repairs to the interlock."

The licensee has notified the NRC Resident Inspector.

Page Last Reviewed/Updated Thursday, February 18, 2016
Thursday, February 18, 2016