Event Notification Report for October 30, 2025

EN Revision Imported Date: 10/30/2025

EN Revision Text: AGREEMENT STATE REPORT - CONTAMINATION DETECTED IN SHIPPING VIAL

The following information was provided by the Illinois Emergency Management Agency (the Agency) via email:

"The Agency was contacted on September 8, 2025, by Bard Brachytherapy in Carol Stream, Illinois, to advise that they had detected contamination in a shipment of (72) TheraSeed Model 200 Pd-103 brachytherapy seeds. This is the second shipment of brachytherapy seeds since August, 2025, in which contamination was identified. The first occurrence identified contamination within the shipping vial and no leaking seeds. That occurrence failed to meet reportable criteria. Both shipments had been received directly from the manufacturer, Theragenics, in Georgia. The contamination did not result in any public or occupational exposures, nor were the licensee's facilities contaminated. However, based on additional information provided on September 11, 2025, this matter is reportable to the Agency under 32 Ill. Adm. Code 340.1230(a)(3)(A), the State's equivalent of 10 CFR 20.2203(a)(3)(i). The seeds have been returned to the manufacturer for investigation and to determine if a seed was leaking or there is a repeat instance of a contaminated shipping vial.

"Details: The shipment consisted of (72) sources at 1.55 millicuries each, for a total consignment of 267.3 millicuries. The brachytherapy seeds are TheraSeed model 200's, under registry number NR-0645-S-101-S. Upon receipt and transfer of brachytherapy seeds to a sterile area, the Illinois licensee surveys the empty shipping vial. It is in this step they identified contamination, later quantified to be approximately 0.013 microcuries. The reportability stems from the fact their license requires testing for contamination prior to incorporating the sources into an implanting device. The reporting threshold is 0.005 microcuries, and thus, this represented the presence of contamination in a restricted area breaching an applicable limit in the license. It is noteworthy a previous incident reported to the Agency on August 21, 2025, also found contamination in a shipping vial, although it did not exceed 0.005 microcuries. The Georgia program was contacted and notified of the incident as well. The licensee met applicable reporting timelines. This report will be updated with any additional information provided by the manufacturer."

Item Number: IL250039

* * * UPDATE ON OCTOBER 29, 2025, AT 0811 EDT FROM KIM STICE TO KAREN COTTON * * *

The following information was provided by the Illinois Emergency Management Agency and Office of Homeland Security via email:

"Update: On 10/21/25, Bard received investigation results from Theragenics which did not confirm if the sources were determined to have been leaking but did state that they concluded that the likely root cause for the contaminated vials was from insufficiencies in the production process. Theragenics also stated their intent to improve the 'transferring of seeds' and 'additional seed swipes' steps in their process. Retraining of staff on seed swiping and visual inspection was also to be conducted.

"This matter may be considered closed pending additional information."

Notified R3DO (Ziolkowski) and NMSS Events Notifications (email).

AGREEMENT STATE REPORT - STOLEN GAUGE

The following is a summary of information provided by the California Department of Public Health, Radiologic Health Branch (the Department) via phone and email:

On October 21, 2025, the radiation safety officer (RSO) of TGR Geotechnical, Inc reported to the Department that a moisture density gauge was stolen from the transport vehicle prior to heading to a worksite in the Los Angeles area. Upon arrival at home, the operator parked the vehicle in their driveway, removed the gauge from the transport case to charge the gauge in the vehicle, and then went inside to have breakfast. Approximately 30 minutes later, the operator found the door of the vehicle open, and the gauge missing. The gauge was a Troxler model 3430 (S/N 34794, 9 mCi Cs-137, 44 mCi Am-241/Be). The RSO had confirmed the gauge trigger lock was secured. The licensee is still investigating the incident. The Department will continue to investigate the incident.

CA incident number: 5010-102125

The following additional information was obtained from the licensee in accordance with Headquarters Operations Officers Report Guidance:

Huntington Park Police Department was notified.

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

AGREEMENT STATE REPORT - LOST STATIC ELIMINATOR

The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:

The licensee reported a static eliminator containing 10 Ci of Po-210 was lost in Wheatridge, Colorado.

Manufacturer: NRD, LLC
Model number: P-2021
Isotope: Po-210
Activity: 10 Ci

Event report ID number: CO250034

THIS MATERIAL EVENT CONTAINS A 'Category 3' LEVEL OF RADIOACTIVE MATERIAL

Category 3 sources, if not safely managed or securely protected, could cause permanent injury to a person who handled them, or were otherwise in contact with them, for some hours. It could possibly - although it is unlikely - be fatal to be close to this amount of unshielded radioactive material for a period of days to weeks. These sources are typically used in practices such as fixed industrial gauges involving high activity sources (for example: level gauges, dredger gauges, conveyor gauges and spinning pipe gauges) and well logging. For additional information go to http://www-pub.iaea.org/MTCD/publications/PDF/Pub1227_web.pdf

AGREEMENT STATE REPORT - LOST EXIT SIGNS

The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:

The licensee reported that three exit signs, each containing 7.03 Ci of tritium, were lost in Broomfield, Colorado.

Manufacturer: Best Lighting Products Inc
Model number: SLXTU1BB10
Isotope: H-3
Activity: 21.09 Ci (total)

Event report ID number: CO250032

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

AGREEMENT STATE REPORT - LOST EXIT SIGN

The following is a summary of information provided by the Colorado Department of Public Health and Environment via email:

The licensee reported that one exit sign, containing 6.2 Ci of tritium, was lost in Thornton, Colorado.

Manufacturer: Isolite Corporation
Model number: 880-12-6
Isotope: H-3
Activity: 6.2 Ci total

Event report ID number: CO250033

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

AGREEMENT STATE REPORT - DAMAGED MOISTURE DENSITY GAUGE

The following information was provided by the Florida Bureau of Radiation Control (BRC) via email:

"BRC received notification that a Troxler gauge, model 3430 (8 mCi Cs-137, 40 mCi Am-241-Be), was impacted by a bobcat construction vehicle. The yellow case of the gauge is significantly damaged, but the licensee states the source rod was successfully retracted. The area has been roped off with a 20 foot radius. An inspector has been assigned for immediate response."

Florida incident number: FL25-103

AGREEMENT STATE REPORT - MEDICAL EVENT

The following is a summary of information received from the New York City Department of Health via email:

Memorial Sloan Kettering Cancer Center reported a Y-90 TheraSphere treatment to one site in the liver out of four resulting in 20.7 percent less dose than intended. The planned dose to the treatment site was 235 Gy; only 187 Gy was delivered.

The treatment involved four vials to be used. Two of the vials were mistakenly switched during the treatment, resulting in the incorrect dose to one location. The patient was informed.

New York item number: NY250006

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.

OFFSITE NOTIFICATION FOR PERSONNEL INJURY

The following information was provided by the licensee via phone and email:

"At 0920 EDT on 10/28/25, the supervisor of nuclear site safety contacted the area director of OSHA [Occupational Safety and Health Administration] to notify them of a work-related injury which resulted in the employee being admitted to a hospital.

"The individual was not contaminated and was transported offsite to Chippenham Hospital in Richmond, VA.

"This was a 24-hour notification in accordance with 29 CFR 1904.8."

The NRC Resident Inspector has been notified.

RPS ACTUATION AND OFFSITE NOTIFICATION

The following is a summary of information provided by the licensee via phone and email:

At 1904 EDT on 10/28/2025, there was a full reactor scram at Susquehanna Unit 2 from 100 percent power. All systems operated as expected, and the plant is stable in mode 3 with decay heat removal via the main condenser. The cause of the scram is under investigation. Unit 1 was not affected.

Concurrent with the Unit 2 scram, the control room received a report of a fire outside of the protected area near the Susquehanna Steam Electric Station 500-kilovolt switchyard. The local fire department responded to the site with lights and sirens active which caused heightened public concern on social media. An event of potential public interest notification was made to the Pennsylvania Emergency Management Agency (PEMA). It was determined no fire existed, no actions were taken by the offsite fire company, and no personnel were injured during the event.

Whether the reported fire and the reactor scram are related, is being investigated.

This event is being reported under 10 CFR 50.72(b)(2)(iv)(B) and 10 CFR 50.72(b)(2)(xi) for the unplanned actuation of the reactor protection system while the reactor is critical and for the offsite notification to PEMA.

The NRC Resident Inspector has been notified.

FITNESS FOR DUTY EVENT - PROGRAMMATIC FAILURE

The following information was provided by the licensee via phone and email:

"At 0815 CDT, on October 29, 2025, fitness-for-duty (FFD) program administrators identified that a contract employee, who was required to be part of the FFD program random testing pool, had been inadvertently removed from the pool on October 20, 2025. The employee's protected area access has been placed on hold in accordance with the station process. The issue has been placed into the site corrective action program for further review and evaluation to determine the cause. This event notification is being made in accordance with 10 CFR 26.719(b)(4).

"The NRC Resident Inspector has been notified."