Injury Line: Village Pantry Store 481
| Inspection Nr | 101952877 |
| Investigation Nr | 671420 |
| Line Nr | 1 |
| Age | |
| Sex |   |
| Nature of Injury | Cut/Laceration |
| Part of Body | Head |
| Source of Injury | Gases |
| Event Type | Struck By |
| Environmental Factor | Flying Object Action |
| Human Factor | Other |
| Occupation | Supervisors and proprietors, sales occupations |
| Degree of Injury | Fatality |
| Task Assigned | Task regularly assigned |
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