Event Notification Report for December 31, 2001
U.S. Nuclear Regulatory Commission
Operations Center
Event Reports For
12/28/2001 - 12/31/2001
** EVENT NUMBERS **
38587 38598 38599
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|Hospital |Event Number: 38587 |
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| REP ORG: PARK VIEW HOSPITAL |NOTIFICATION DATE: 12/20/2001|
|LICENSEE: PARK VIEW HOSPITAL |NOTIFICATION TIME: 11:09[EST]|
| CITY: FT. WAYNE REGION: 3 |EVENT DATE: 12/19/2001|
| COUNTY: STATE: IN |EVENT TIME: [CST]|
|LICENSE#: 13-01284-02 AGREEMENT: N |LAST UPDATE DATE: 12/28/2001|
| DOCKET: |+----------------------------+
| |PERSON ORGANIZATION |
| |MONTE PHILLIPS R3 |
| |JOHN HICKEY NMSS |
+------------------------------------------------+ |
| NRC NOTIFIED BY: JOHN AGNEW | |
| HQ OPS OFFICER: CHAUNCEY GOULD | |
+------------------------------------------------+ |
|EMERGENCY CLASS: NON EMERGENCY | |
|10 CFR SECTION: | |
|LADM 35.33(a) MED MISADMINISTRATION | |
| | |
| | |
| | |
| | |
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EVENT TEXT
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| POSSIBLE MEDICAL MISADMINISTRATIONS COULD HAVE OCCURRED DURING
THERAPEUTIC |
| TREATMENTS IN 1998. |
| |
| A radiopharmacy (Spectrum Co.) supplied the hospital with incorrectly |
| calibrated doses of samarium-153 which were used in 1998 during three |
| (04/15/98, 06/03/98, and 06/10/98) therapeutic treatments for bone pain. |
| The supplier believes the doses may be 20-30% less than what was calculated. |
| They are currently performing calculations to determine what the doses were |
| and have already reported this problem to the NRC. The hospital was |
| notified on 12/19/01 of this calculation error. |
| |
| ***** UPDATE RECEIVED AT 1437 EST ON 12/28/01 FROM JOHN AGNEW TO LEIGH |
| TROCINE ***** |
| |
| The licensee is updating this event notification to provide the actual doses |
| received during the treatments in question. |
| |
| The written directive for the 04/15/98 treatment was 90 millicuries of |
| samarium-153, and the radiopharmacy recalculated the actual dose to be 67.18 |
| millicuries. The written directive for the 06/03/98 treatment was 54 |
| millicuries of samarium-153, and the radiopharmacy recalculated the actual |
| dose to be 42.44 millicuries. The written directive for the 06/10/98 |
| treatment was 54 millicuries of samarium-153, and the radiopharmacy |
| recalculated the actual dose to be 41.14 millicuries. |
| |
| The NRC operations officer notified the R3DO (Brent Clayton) and NMSS EO |
| (Fred Brown). |
| |
| (Call the NRC operations officer to obtain contact telephone numbers for |
| John Agnew and for Spectrum.) |
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|Power Reactor |Event Number: 38598 |
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| FACILITY: PILGRIM REGION: 1 |NOTIFICATION DATE: 12/27/2001|
| UNIT: [1] [] [] STATE: MA |NOTIFICATION TIME: 16:03[EST]|
| RXTYPE: [1] GE-3 |EVENT DATE: 12/27/2001|
+------------------------------------------------+EVENT TIME: 13:21[EST]|
| NRC NOTIFIED BY: DOUG PERRY |LAST UPDATE DATE: 12/29/2001|
| HQ OPS OFFICER: LEIGH TROCINE +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |MICHELE EVANS R1 |
|10 CFR SECTION: | |
|ARPS 50.72(b)(2)(iv)(B) RPS ACTUATION - CRITICA| |
|AESF 50.72(b)(3)(iv)(A) VALID SPECIF SYS ACTUAT| |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE
|
+-----+----------+-------+--------+-----------------+--------+-----------------+
|1 A/R Y 100 Power Operation |0 Hot Shutdown |
| | |
| | |
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EVENT TEXT
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| REACTOR SCRAM AFTER TWO RECIRCULATION MOTOR-GENERATOR (MG) SETS
TRIPPED |
| DURING THE PERFORMANCE OF ANTICIPATED TRANSIENT WITHOUT SCRAM (ATWS)
LOGIC |
| TESTING |
| |
| The following text is a portion of a facsimile received from the licensee: |
| |
| "While performing ATWS logic testing, both [the] 'A' [and] 'B' |
| [recirculation] MG sets tripped, and the reactor was scrammed. The cause of |
| the scram is being determined at this time. All control rods fully inserted |
| on the scram. All safety systems functioned properly during the transient. |
| The plant is in the process of being maneuvered to Cold Shutdown." |
| |
| The licensee stated that the main steam isolation valves remained open and |
| that none of the safety relief valves lifted. In addition, there were no |
| emergency core cooling system actuations, and none were required. The |
| reported engineered safety feature actuation was the actuation of the |
| reactor protection system. |
| |
| The unit is currently stable in Hot Shutdown. Normal condensate and |
| feedwater is being utilized to supply water to the reactor vessel, and the |
| condenser is being utilized as a heat sink. Containment parameters are |
| normal, offsite power is available, and the electrical grid is stable. The |
| emergency diesel generators and engineered safety feature systems are |
| available if needed. |
| |
| The licensee stated that the ATWS logic test procedure was not new and that |
| it had been performed on several occasions in the past. The ATWS logic test |
| was successfully completed for the 'A' side earlier today, and the plant |
| transient occurred during the performance of the ATWS logic test for the 'B' |
| side. The cause of the recirculation MG set trips is currently under |
| investigation. |
| |
| The licensee notified the NRC resident inspector. |
| |
| * * * UPDATED AT 0023 ON 12/29/01 BY ERIC OLSON TO FANGIE JONES * * * |
| |
| The licensee reported the cause of the scram as Average Power Range (APR) |
| Hi-Hi trip caused by a flow control trip reference card signal from the low |
| flow due the trip of both recirc pumps. |
| |
| The NRC Resident Inspector has been informed by the licensee. The R1DO |
| (Michele Evans) has been informed. |
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|Power Reactor |Event Number: 38599 |
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| FACILITY: SALEM REGION: 1 |NOTIFICATION DATE: 12/31/2001|
| UNIT: [] [2] [] STATE: NJ |NOTIFICATION TIME: 02:00[EST]|
| RXTYPE: [1] W-4-LP,[2] W-4-LP |EVENT DATE: 12/31/2001|
+------------------------------------------------+EVENT TIME: 00:10[EST]|
| NRC NOTIFIED BY: S. SAUER |LAST UPDATE DATE: 12/31/2001|
| HQ OPS OFFICER: FANGIE JONES +-----------------------------+
+------------------------------------------------+PERSON ORGANIZATION |
|EMERGENCY CLASS: NON EMERGENCY |MICHELE EVANS R1 |
|10 CFR SECTION: | |
|ACCS 50.72(b)(2)(iv)(A) ECCS INJECTION | |
|ARPS 50.72(b)(2)(iv)(B) RPS ACTUATION - CRITICA| |
| | |
| | |
+-----+----------+-------+--------+-----------------+--------+-----------------+
|UNIT |SCRAM CODE|RX CRIT|INIT PWR| INIT RX MODE |CURR PWR| CURR RX MODE
|
+-----+----------+-------+--------+-----------------+--------+-----------------+
| | |
|2 A/R Y 100 Power Operation |0 Hot Standby |
| | |
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EVENT TEXT
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| REACTOR TRIP AND SAFETY INJECTION DUE TO SPRAY VALVE FAILING OPEN |
| |
| The unit experienced a reactor trip and safety injection as a result of a |
| pressurizer spray valve (2PS3) failing open. This caused a reactor trip on |
| Overtemperature DeltaT and a safety injection on low reactor coolant system |
| pressure. All emergency equipment responded properly, all safety injection |
| pumps started and all control rods fully inserted. The emergency diesels |
| started, but did not load as designed. The auxiliary feedwater pumps |
| started on low steam generator level. The pressurizer spray valve closed |
| when the valve's operating air was isolated. |
| |
| The unit is stable in Mode 3 (Hot Standby) at normal temperature and |
| pressure. Auxiliary feedwater and steam dumps are in use to maintain steam |
| generator level and remove excess heat. An investigation of the failure is |
| underway. |
| |
| The licensee intends to notify the NRC Resident Inspector and the local |
| Township. |
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Page Last Reviewed/Updated Thursday, March 25, 2021