| Type of Incident: | Injury |
| Match Number: | |
| Date of Incident: | 2013-10-05 |
| Time of Incident: | 03:30:00 |
| Location of Incident: | 5 fractures to my left orbit eye ,concussion |
| Competition: | 2013_SOR_NPL_ |
| Home Team: | atlas selection team under 14 |
| Visiting Team: | san jose earthquicks |
| Age Group and Gender: | U14B |
| Team Affiliation of Individual Committing Incident: | |
| Incident Summary: | Not a NorCal incident |
| Comments: | This is not a NorCal incident |
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