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| Inspection Nr | 106928286 |
| Investigation Nr | 170119945 |
| Line Nr | 3 |
| Age | |
| Sex | |
| Nature of Injury | Asphyxia |
| Part of Body | Lung |
| Source of Injury | Fire/Smoke |
| Event Type | Inhalation |
| Environmental Factor | Flammable Liq/Solid Exposure |
| Human Factor | Safety Devices Removed/Inoper. |
| Occupation | Occupation not reported |
| Degree of Injury | Fatality |
| Task Assigned | Task not regularly assigned |
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