United States Nuclear Regulatory Commission - Protecting People and the Environment
Home > NRC Library > Document Collections > Reports Associated with Events > Event Notification Reports > 2017 > October 17

Event Notification Report for October 17, 2017

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
10/16/2017 - 10/17/2017

** EVENT NUMBERS **


53001 53006 53018 53019

To top of page
Agreement State Event Number: 53001
Rep Org: MARYLAND DEPT OF THE ENVIRONMENT
Licensee: JOHNS HOPKINS OUTPATIENT CENTER
Region: 1
City: BALTIMORE State: MD
County:
License #: MD-07-005-03
Agreement: Y
Docket:
NRC Notified By: ALAN GOLDEY
HQ OPS Officer: DONALD NORWOOD
Notification Date: 10/06/2017
Notification Time: 13:11 [ET]
Event Date: 10/05/2017
Event Time: [EDT]
Last Update Date: 10/06/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
DON JACKSON (R1DO)
NMSS_EVENTS_NOTIFICA (EMAI)

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

Event Text

AGREEMENT STATE REPORT - LOST BRACHYTHERAPY SEED

"On October 5, 2017, Johns Hopkins Outpatient Center, notified the Maryland Radiological Health Program (RHP) that on October 5, 2017, following a prostate seed implant procedure, the licensee discovered that one (1) seed was unaccounted for. The Pd-103 seed has an activity of approximately 1.5 milliCuries. The number of seeds implanted into the patient was 42 out of 47 seeds ordered. Four (4) seeds remained in the applicator. This left one (1) seed unaccounted for. Two physicists counted 42 seeds implanted, verified on two separate C-arm images. All personnel were scanned with a sodium iodide survey meter as they exited the room. All equipment, tables, waste bags, surgical covers, linens, etc. were scanned multiple times. The floor was systematically and methodically scanned, including the patient's Foley bag, with negative results.

"The patient will return tomorrow [October 6, 2017] for a follow-up CT and chest x-ray. Radiation Oncology will re-count the seeds. Theragenics Corporation will also be contacted to determine if only 46 seeds were shipped. These seeds are received precalibrated and presterilized.

"A reactive inspection will be conducted to investigate this event."

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: 53006
Rep Org: CALIFORNIA RADIATION CONTROL PRGM
Licensee: MILLENNIUM CONSULTING ASSOCIATES
Region: 4
City: OAKLAND State: CA
County:
License #: N/A
Agreement: Y
Docket:
NRC Notified By: EPHRIME MEKURIA
HQ OPS Officer: MARK ABRAMOVITZ
Notification Date: 10/09/2017
Notification Time: 19:48 [ET]
Event Date: 10/08/2017
Event Time: 14:17 [PDT]
Last Update Date: 10/09/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
RAY KELLAR (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)

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

Event Text

AGREEMENT STATE REPORT - STOLEN Cd-109 SOURCE

The following report was received via e-mail:

"California OES [Office of Emergency Services] notified RHB [Radiation Health Branch] Sacramento of the following hazardous material spill report on October 8, 2017:

"On October 8, 2017, at 1417 [PDT], XRF equipment user, from Millennium Consulting Associates, notified Cal OES that the Niton XRF equipment, Model XLp303, S/N 21870, he uses was stolen from his vehicle that was parked in front of his residence in Alameda. CA. The theft was noticed by the licensee on Sunday October 08, 2017 about 1145.

"The Niton XLp300 contains a licensed material Cd-109, 40 mCi as of 08/28/16. [The licensee] reported this incident to the Alameda Police on October 8, 2017at 14:45, the Case # is 17-5776."

California Report Number: 5010-100817

A Niton XLp300 is used to analyze lead content.

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
Power Reactor Event Number: 53018
Facility: VOGTLE
Region: 2 State: GA
Unit: [3] [4] [ ]
RX Type: [3] W-AP1000,[4] W-AP1000
NRC Notified By: DANIEL MICKINAC
HQ OPS Officer: STEVEN VITTO
Notification Date: 10/16/2017
Notification Time: 17:59 [ET]
Event Date: 10/16/2017
Event Time: 08:51 [EDT]
Last Update Date: 10/16/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
26.719 - FITNESS FOR DUTY
Person (Organization):
STEVE ROSE (R2DO)
FFD GROUP (EMAI)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
3 N N 0 Under Construction 0 Under Construction
4 N N 0 Under Construction 0 Under Construction

Event Text

FITNESS FOR DUTY - NON LICENSED SUPERVISOR SUBVERTED TEST

"A non-licensed supervisory contractor subverted a random Fitness for Duty (FFD) test. At 0851 [EDT] on October 16, 2017, a contractor supervisor was notified to report for a random FFD test and [the individual] did not report to the testing facility and left the premises. The contractor's site access has been terminated. The NRC Resident Inspector was notified."

To top of page
Power Reactor Event Number: 53019
Facility: PRAIRIE ISLAND
Region: 3 State: MN
Unit: [ ] [2] [ ]
RX Type: [1] W-2-LP,[2] W-2-LP
NRC Notified By: PHILIP SNIDER
HQ OPS Officer: DONALD NORWOOD
Notification Date: 10/16/2017
Notification Time: 22:09 [ET]
Event Date: 10/16/2017
Event Time: 14:25 [CDT]
Last Update Date: 10/16/2017
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(A) - DEGRADED CONDITION
Person (Organization):
ROBERT DALEY (R3DO)

Unit SCRAM Code RX CRIT Initial PWR Initial RX Mode Current PWR Current RX Mode
2 N N 0 Cold Shutdown 0 Cold Shutdown

Event Text

REACTOR COOLANT SYSTEM SHUTDOWN COMMUNICATION LINE VENT THROUGH WALL DEFECT

"At 1425 CDT on 10/16/17, investigation into a boric acid indication was determined to be a through wall leak at the socket weld that joins the 3/4 inch line 2RC-92 to valve 2RC-8-37. Unit 2 is currently in Mode 5 with Reactor Coolant system (RCS) Operational Leakage limits not applicable. The leak is downstream of two first off RCS isolation valves that are normally closed. The leak is not quantifiable as it only consists of a small amount of dry boric acid at the location. This failure constitutes welding or material defects in the primary coolant system that cannot be found acceptable under ASME Section Xl.

"Therefore, this is a degraded condition reportable under 10 CFR 50.72(b)(3)(ii)(A).

"At the time of this notification, the Prairie Island Nuclear Generating Plant Unit 2 is in Mode 5 for a planned refueling outage. The identified defect will be repaired prior to entering Mode 4.

"This condition does not affect the health and safety of the public or station employees. The NRC Resident Inspector has been notified."

Page Last Reviewed/Updated Tuesday, October 17, 2017
Tuesday, October 17, 2017