| Type of Incident: | Injury |
| Match Number: | |
| Date of Incident: | 2013-09-08 |
| Time of Incident: | 01:20:00 |
| Location of Incident: | Christensen Middle School Livermore, CA |
| Competition: | 2013_SOR_NCSC_ |
| Home Team: | West Coast Wiked |
| Visiting Team: | SC Qual Diablo FC Blue |
| Age Group and Gender: | U16G |
| Team Affiliation of Individual Committing Incident: | |
| Incident Summary: | Injury |
| Comments: | Please contact US Club Soccer with any questions |
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