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ASN Wikibase Occurrence # 223675
Last updated: 24 November 2020
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Date:29-MAR-2019
Time:09:05 UTC
Type:Silhouette image of generic B788 model; specific model in this crash may look slightly different
Boeing 787-8 Dreamliner
Owner/operator:Jetstar Airways
Registration: VH-VKJ
C/n / msn: 36236/278
Fatalities:Fatalities: 0 / Occupants:
Other fatalities:0
Aircraft damage: None
Category:Serious incident
Location:near Osaka-Kansai International Airport -   Japan
Phase: Approach
Nature:Passenger - Scheduled
Departure airport:Cairns Airport, QLD (CNS/YBCS)
Destination airport:Osaka-Kansai International Airport (KIX/RJBB)
Investigating agency: JTSB
Narrative:
At approximately 15,000 feet during descent into Kansai International Airport, Osaka, Japan, the flight crew of Jetstar Airways flight JQ15 received an engine thrust warning on the number 2 engine, which subsequently started to surge. The crew then received an engine fail indication on the number 1 engine, without any shift in parameters indicating any engine power loss.
That warning was followed by an engine fail warning on the number 2 engine. The number 2 engine auto relight activated and the engine continued to surge during the descent.

High concentrations of biocide in outer tanks resulted in magnesium salt residue jamming fuel controls at low fuel flows, so both engines momentarily dropped below idle of descent.

PROBABLE CAUSES:
In this serious incident, it is highly probable that, when the Aircraft was descending for landing, there occurred oscillation in rpm of each engine causing both engines to temporarily fall below idle at separate times because Residue primarily composed of magnesium salts accumulated in spools impeded movement of spools that involved in fuel metering of both engines.
As for the higher accumulation of Residue primarily composed magnesium salts in spools, it is somewhat likely that the fuel with a higher concentration ratio of biocide, which was loaded in the biocide treatment two days before the serious incident, did not mixed evenly with the remaining fuel in wing tanks, and was fed to the engines.

Sources:

https://mainichi.jp/english/articles/20190403/p2g/00m/0bu/002000c
https://www.atsb.gov.au/publications/investigation_reports/2019/aair/ae-2019-016/
https://www.smh.com.au/business/companies/jetstar-787-suffers-problems-with-both-engines-on-approach-to-osaka-20190327-p5183s.html
http://aerossurance.com/safety-management/jetstar-b787-genx-biocide
https://jtsb.mlit.go.jp/jtsb/aircraft/detail2.php?id=2235
https://www.mlit.go.jp/jtsb/eng-air_report/VHVKJ.pdf
https://www.flightradar24.com/data/aircraft/vh-vkj#1ff78570

Accident investigation:
cover
  
Investigating agency: JTSB
Status: Investigation completed
Duration:
Download report: Final report

Media:


Images:

Photo of VH-VKJ courtesy AirHistory.net


Sydney - Kingsford Smith International (YSSY / SYD)
11 September 2016; (c) Phil


Revision history:

Date/timeContributorUpdates
03-Apr-2019 07:45 mtchastain Added
03-Apr-2019 07:47 harro Updated [Time, Cn, Nature, Departure airport, Destination airport, Source, Narrative]
03-Apr-2019 07:50 harro Updated [Location, Source, Narrative]
03-Apr-2019 10:57 harro Updated [Photo]
25-Jun-2020 11:10 Aerossurance Updated [Source, Narrative]
25-Jun-2020 11:19 Aerossurance Updated [Embed code, Narrative]
24-Jul-2020 12:35 harro Updated [Embed code, Narrative, Accident report, ]

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