| Type of Incident: | Injury |
| Match Number: | 1616 |
| Date of Incident: | 2023-09-10 |
| Time of Incident: | 10:20:00 |
| Location of Incident: | Larchmont Community Park Field 3 |
| Competition: | 2023 NorCal State Cup |
| Home Team: | Union Sacrament FC 13B JDP |
| Visiting Team: | Fruitridge SC FSC 2013B Warriors |
| Age Group and Gender: | U11B |
| Team Affiliation of Individual Committing Incident: | Union Sacrament FC 13B JDP |
| Incident Summary: | Injury Report |
| Comments: | Injury Report - no action taken. |
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