Event Notification Report for March 1, 2018

U.S. Nuclear Regulatory Commission
Operations Center

Event Reports For
02/28/2018 - 03/01/2018

** EVENT NUMBERS **


53159 53224 53225

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Power Reactor Event Number: 53159
Facility: FARLEY
Region: 2 State: AL
Unit: [1] [2] [ ]
RX Type: [1] W-3-LP,[2] W-3-LP
NRC Notified By: RICHARD LANGFORD
HQ OPS Officer: DONALD NORWOOD
Notification Date: 01/09/2018
Notification Time: 23:38 [ET]
Event Date: 01/09/2018
Event Time: 17:59 [CST]
Last Update Date: 02/28/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
50.72(b)(3)(ii)(B) - UNANALYZED CONDITION
Person (Organization):
FRANK EHRHARDT (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

UNANALYZED CONDITION IDENTIFIED DURING NATIONAL FIRE PROTECTION ASSOCIATION 805 IMPLEMENTATION

"On January 9, 2018, at 1759 CST, during review of NFPA 805 requirements and circuit analysis, it was determined that the NFPA 805 analysis and Fire Safe Shutdown Modeling did not consider all fire-induced failures. As such, a condition could possibly exist during a postulated fire where both safety related electrical trains could be impacted.

"This notification is to report a condition involving the fire safe shutdown analysis. The condition could result in an adverse impact on the ability of operators to respond to a postulated fire in these areas. Therefore, this notification is being made pursuant to 10 CFR 50.72(b)(3)(ii)(B), any event or condition that results in the nuclear power plant being in an unanalyzed condition that significantly degrades plant safety.

"Compensatory fire watches have been established in the affected areas."

The licensee notified the NRC Resident Inspector.


* * * RETRACTION FROM ANTONIO BENFORD TO HOWIE CROUCH AT 1752 EST ON 2/28/18 * * *

"Following additional refinements to the NFPA 805 Fire PRA Model, the circuits which initiated the initial report of an unanalyzed condition have now been evaluated and have proven that no significant degradation to plant safety existed. Therefore, EN 53159 is being retracted.

"The NRC Resident Inspector has been notified."

Notified R2DO (Michel).

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!!!!! THIS EVENT HAS BEEN RETRACTED. THIS EVENT HAS BEEN RETRACTED !!!!!
Non-Agreement State Event Number: 53224
Rep Org: SAINT MARY'S HEALTH CARE
Licensee: SAINT MARY'S HEALTH CARE
Region: 3
City: GRAND RAPIDS State: MI
County:
License #: 21-01078-01
Agreement: N
Docket:
NRC Notified By: TRISTON DOUGALL
HQ OPS Officer: OSSY FONT
Notification Date: 02/21/2018
Notification Time: 15:33 [ET]
Event Date: 02/20/2018
Event Time: 12:00 [EST]
Last Update Date: 02/22/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
35.3045(a)(1) - DOSE <> PRESCRIBED DOSAGE
Person (Organization):
HIRONORI PETERSON (R3DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

DOSE TO PATIENT LESS THAN THE INTENDED DOSE

A patient was administered the radiopharmaceutical Xofigo which contains Radium Dichloride (Ra-223 CL2). The dosage is based on patient weight. The patient was administered 119.1 microCi. The patient was then weighed and found to weigh greater than 25 percent more than the weight used to calculate the dosage. This was the fourth treatment session of six prescribed. The referring physician's intended dose would have been 159 microCi, based on the patient's actual weight. This misadministration is being characterized as a personnel error.

The patient and the physician have been notified and treatment will continue.

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 ON 02/22/2018 AT 1541EST FROM TRISTON DOUGALL TO STEVEN VITTO * * *

The Licensee determined that the written directive was followed and therefore this event does not qualify as a misadministration.

Notified R3DO(Peterson) and NMSS Events Notification email.

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Agreement State Event Number: 53225
Rep Org: TEXAS DEPT OF STATE HEALTH SERVICES
Licensee: KEANE FRAC LP
Region: 4
City: HOUSTON State: TX
County:
License #:
Agreement: Y
Docket:
NRC Notified By: KAREN BLANCHARD
HQ OPS Officer: DONALD NORWOOD
Notification Date: 02/21/2018
Notification Time: 16:20 [ET]
Event Date: 02/20/2018
Event Time: [CST]
Last Update Date: 02/21/2018
Emergency Class: NON EMERGENCY
10 CFR Section:
AGREEMENT STATE
Person (Organization):
GREG PICK (R4DO)
NMSS_EVENTS_NOTIFICA (EMAI)

Event Text

AGREEMENT STATE REPORT - GAUGE SHUTTER STUCK

The following information was received via E-mail:

On February 21, 2018, the licensee notified the Agency that on February 20, 2018, routine inspection and maintenance was being performed on a Berthold model LB 8010 gauge containing a 20 millicurie cesium-137 source that was in storage at its facility. During shutter check, the shutter was stiff during opening and then it would not close. The shutter was stuck in the open position. The licensee reported that the storage area is segregated from work areas and no one has received any exposure as a result of this event. The few employees with access to the area where the gauge is located have been notified of the situation. The manufacturer was contacted and repair scheduled. Information will be provided as it is obtained and in accordance with SA-300.

Texas Incident #: I-9544

Page Last Reviewed/Updated Wednesday, March 24, 2021