| Type of Incident: | Injury |
| Match Number: | |
| Date of Incident: | 2012-09-22 |
| Time of Incident: | 05:30:00 |
| Location of Incident: | Albert Einstein Jr. High, Sacramento, CA |
| Competition: | 2012_SOR_FALL_ |
| Home Team: | CapFC United 95 Red |
| Visiting Team: | East Bay Oaks Arsenal |
| Age Group and Gender: | U17B |
| Team Affiliation of Individual Committing Incident: | |
| Incident Summary: | Injured Player |
| Comments: | NorCal PAD has noted the injury |
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