Tañon College Inc.

E.A ANTONIO JR. MEMORIAL SCHOOL

HEALTH SERVICES INCIDENT REPORT

Date of Report: ______________

Incident No.: _____________

INCIDENT INFOMATION

Last Thursday, March 16, 2023, three (3) students from Grade 7 (1 Hebe/2 Hera) were
brought to the clinic because they suffered from moderate vomiting (4-5x), and abdominal pain. I
gave immediate nursing management to the said students, then informed their parents to fetch
them and to seek medical attention because symptoms persist.

Two students, Descartin, Princess Kiel and Lim were brought to the hospital by their
parents. Descartin was admitted for 3 days and student Lim was on out-patient only, the doctor
prescribed medicines to be taken at home. Patient Señora was brought by her mother home for
the symptoms subsided already.

What they ate?

Descarten – Biscuit, siomai rice (Maricar), egg, hotdog rice, mineral water
Lim – Chicken joy (outside the school), Siomai rice (Inside the school)
Señora – Longganisa, egg, chicken joy, Siomai rice (Inside the school), mineral water

DIAGNOSIS:

Patient’s name: Princess Kiel Descarten Grade: 7 HEBE

Time: 12:00 NN
C/C: Abdominal Pain and moderate vomiting

Patient’s name: Christ John Lim Grade: 7 HERA

Time: 1:00 PM
C/C: Abdominal Pain

Patient’s name: Señora, Mae Chelle Grade: 7 HERA

Time: 12:00 NN
C/C: moderate vomiting

Reported by: _______________________

Title/Role: ______________________

Noted by:

Leyte Gerodias Ma. Ligaya Saministrado

Students Affairs Coordinator Principal

Cynthia A. Sanchez
School Administrator