MIRF REPORT
Request:
Anaphylactic reaction
Campus:
Vista
Location/Building:
[68]
Date of Incident:
August 17, 2025
Time of Incident:
12:20 PM
Number of Patients for this Incident:
[75]
List Patient(s) Name, Age, Parent/Guardian (if under 18),… :
Heather Smith 35y/o DOB 6/20/94
904-315-7807
Describe Medical Event:
While volunteering with preschool kids. Heather states the children harvested tomatoes and then touched her. She developed hives in both hands and started clearing her throat. She changed her T-shirt. Preschool staff called medical safety team and asked for Benadryl.
Actions Taken by Team Members:
[79]
Number of NCSM Team Members Involved:
[81]
List Name(s) of NCSM Team Members Involved:
Alice Besong
Pete Hahn
Was medical attention accepted?”:
Yes
Medical attention was refused by (name and relationship to… :
Was 911 emergency service called?:
Yes
Was patient transported via 911 emergency services?:
Yes
What hospital was victim transported to?:
not sure
NCS team lead:
[249]
If any revisions or updates are needed to be made to this incident, complete the form below.
Please select a valid form