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Fatal Crash Report

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Crash #2021550383 Crash #2021550383
Fatalities 1
State WISCONSIN
County SHAWANO
City
Date Aug. 20, 2021
Time 4:40 p.m.
Location(44.8240361, -89.1215917) - Fatality Map - Google Maps
Street Name 1 SR-29
Street Name 2 nan
WeatherClear
Number of Vehicles 1
Number of Vehicles in Transport 1
Number of Parked Vehicles 0
Number of Persons in Motor Vehicles 4
Number of Persons in Motor Vehicles in Transport 4
Number of Persons in Parked Vehicles 0
Number of Nonmotorists 0
Route Signing State Highway
Rural / Urban Rural
Functional System Other Principal Arterial
Road Owner State Highway Agency
National Highway System Part of the National Highway System
Special Jurisdiction No Special Jurisdiction (Includes National Forests Since 2008)
Milepoint 99998
First Harmful Event Cargo/Equipment Loss, Shift, or Damage (Harmful)
Manner of Collision First Harmful Event was Not a Collision with Motor Vehicle In-Transport
At Intersection No
Relation to Junction Non-Junction
Type of Intersection Not an Intersection
Relation to Road On Roadside
Work Zone None
Light Condition Daylight
Atmospheric Condition Clear
School Bus Related False
Rail Grade Crossing ID 0000000
EMS Notified Hour 17
EMS Notified Minute 0
EMS Arrived Hour 17
EMS Arrived Minute 0
Crash Related FactorNone Noted
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Persons

Person #1 in Vehicle #1 Person #1 in Vehicle #1
Age 56 year(s) old
SexMale
Person TypeDriver of a Motor Vehicle In-Transport
Injury SeverityFatal Injury (K)
Seating PositionFront Seat, Left Side (Driver's Side)
Restraint System UseUnknown/Reported as Unknown (Since 2018)
Restraint System MisuseNone Used/Not Applicable
Helmet UseNot Applicable
Helmet MisuseNone Used/Not Applicable
Airbag DeployedReported as Deployment Unknown
EjectionNot Ejected
Ejection PathEjection Path Not Applicable
ExtricationNot Extricated/Not Applicable
Police Reported Alcohol InvolvementNo (Alcohol Not Involved)
Alcohol Test GivenTest Given
Alcohol Test TypeBlood Test
Alcohol Test Result0.0
Police Reported Drug InvolvementNo (Drugs Not Involved)
Drug TestedTest Given
Transported To Medical Facility ByNot Transported for Treatment
Died En RouteDied at Scene
Month of DeathAugust
Day of Death20
Year of Death2021
Hour of Death16
Minute of Death40
Lag Hours0
Lag Minutes0
Non Motorist LocationOccupant of a Motor Vehicle (Includes Railway Train Occupants Since 2006)
At WorkNo
HispanicNon-Hispanic
Race White
Person Related Factor None Noted
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Person #2 in Vehicle #1 Person #2 in Vehicle #1
Age 57 year(s) old
SexFemale
Person TypePassenger of a Motor Vehicle In-Transport
Injury SeveritySuspected Serious Injury (A)
Seating PositionFront Seat, Right Side
Restraint System UseUnknown/Reported as Unknown (Since 2018)
Restraint System MisuseNone Used/Not Applicable
Helmet UseNot Applicable
Helmet MisuseNone Used/Not Applicable
Airbag DeployedReported as Deployment Unknown
EjectionNot Ejected
Ejection PathEjection Path Not Applicable
ExtricationNot Extricated/Not Applicable
Police Reported Alcohol InvolvementNo (Alcohol Not Involved)
Alcohol Test GivenTest Not Given
Alcohol Test TypeNot Tested for Alcohol
Alcohol Test ResultNone Given
Police Reported Drug InvolvementNo (Drugs Not Involved)
Drug TestedTest Not Given
Transported To Medical Facility ByEMS Air
Died En RouteNot Applicable
Non Motorist LocationOccupant of a Motor Vehicle (Includes Railway Train Occupants Since 2006)
At WorkNot Aplicable
HispanicNot a Fatality (Not Applicable)
Race Not a Fatality (Not Applicable)
Person Related Factor None Noted
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Person #3 in Vehicle #1 Person #3 in Vehicle #1
Age 3 year(s) old
SexMale
Person TypePassenger of a Motor Vehicle In-Transport
Injury SeveritySuspected Serious Injury (A)
Seating PositionSecond Seat, Left Side
Restraint System UseUnknown/Reported as Unknown (Since 2018)
Restraint System MisuseNone Used/Not Applicable
Helmet UseNot Applicable
Helmet MisuseNone Used/Not Applicable
Airbag DeployedReported as Deployment Unknown
EjectionNot Ejected
Ejection PathEjection Path Not Applicable
ExtricationNot Extricated/Not Applicable
Police Reported Alcohol InvolvementNo (Alcohol Not Involved)
Alcohol Test GivenTest Not Given
Alcohol Test TypeNot Tested for Alcohol
Alcohol Test ResultNone Given
Police Reported Drug InvolvementNo (Drugs Not Involved)
Drug TestedTest Not Given
Transported To Medical Facility ByEMS Air
Died En RouteNot Applicable
Non Motorist LocationOccupant of a Motor Vehicle (Includes Railway Train Occupants Since 2006)
At WorkNot Aplicable
HispanicNot a Fatality (Not Applicable)
Race Not a Fatality (Not Applicable)
Person Related Factor None Noted
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Person #4 in Vehicle #1 Person #4 in Vehicle #1
Age 6 year(s) old
SexMale
Person TypePassenger of a Motor Vehicle In-Transport
Injury SeveritySuspected Serious Injury (A)
Seating PositionSecond Seat, Right Side
Restraint System UseUnknown/Reported as Unknown (Since 2018)
Restraint System MisuseNone Used/Not Applicable
Helmet UseNot Applicable
Helmet MisuseNone Used/Not Applicable
Airbag DeployedReported as Deployment Unknown
EjectionNot Ejected
Ejection PathEjection Path Not Applicable
ExtricationNot Extricated/Not Applicable
Police Reported Alcohol InvolvementNo (Alcohol Not Involved)
Alcohol Test GivenTest Not Given
Alcohol Test TypeNot Tested for Alcohol
Alcohol Test ResultNone Given
Police Reported Drug InvolvementNo (Drugs Not Involved)
Drug TestedTest Not Given
Transported To Medical Facility ByEMS Air
Died En RouteNot Applicable
Non Motorist LocationOccupant of a Motor Vehicle (Includes Railway Train Occupants Since 2006)
At WorkNot Aplicable
HispanicNot a Fatality (Not Applicable)
Race Not a Fatality (Not Applicable)
Person Related Factor None Noted
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Moving Vehicles

Vehicle #1 Vehicle #1
Fatalities 1
Number of Occupants 4
Hit and Run No Hit and Run
NCSA Make Ford
Body Type Utility Station Wagon
NCSA Model 423
Registration State Wisconsin
Registered Vehicle Owner Driver (in This Crash) Not Registered Owner (Other Private Owner)
VIN 1FMNU43S21EC
Model Year 2001
VPIC Make ID 460
VPIC Model ID 2370
VPIC Body Class Sport Utility Vehicle (SUV)/Multi-Purpose Vehicle (MPV)
Body Class Not Applicable
Lower Weight Rating Class 2: 6,001 - 10,000 lbs (2,722 - 4,536 kg)
Upper Weight Rating Class 2: 6,001 - 10,000 lbs (2,722 - 4,536 kg)
Vehicle Trailing One Trailer
Trailer VIN 1 4EZT13223J60
Trailer VIN 2 777777777777
Trailer VIN 3 777777777777
Trailer Weight Rating 1 Not Reported
Trailer Weight Rating 2 No Trailing Units
Trailer Weight Rating 3 No Trailing Units
Jackknife No
Motor Carrier ID 0
Vehicle Configuration Not Applicable
Cargo Body Type Not Applicable
Bus Use Not a Bus
Special Vehicle Use No Special Use Noted
Emergency Vehicle Use Not Applicable
Speed Limit 65
Travel Speed 65
Underride / Override Not Applicable
Rollover Rollover
Rollover Location On Roadside
Initial Contact Point Non-Collision
Extent of Damage Disabling Damage
Vehicle Towed Towed
Most Harmful Event Fire/Explosion
Fire Occurence True
Automated Driving System Present Not Reported
Automated Driving System Level Not Reported
Automated Driving System Engaged Not Reported
Driver Drinking No Drinking
Driver Present Driver Present
Drivers License State Wisconsin
Driver Zip Code 54942
Non CDL License Type Full Driver License
Non CDL License Status Valid
CDL License Status No Commercial Driver's License (CDL)
CDL Endorsements No Endorsements Required for This Vehicle
License Compliance With Class of Vehicle Valid License for This Class Vehicle
Compliance with LIcense Restrictions Restrictions Complied With
Driver Height 71
Driver Weight 260
Previous Recorded Crashes 0
Previous BAC Suspensions (Underage) 0
Previous BAC Suspensions 0
Previous Other Suspensions 0
Previous DWI 0
Previous Speeding Convictions 1
Previous Other Moving Violations 0
Month of Oldest Violation April
Year of Oldest Violation 2018
Month of Newest Violation April
Year of Newest Violation 2018
Speeding Related No
Trafficway Description Two-Way, Divided, Unprotected Median
Total Lanes in Roadway Four Lanes
Roadway Alignment Curve Right
Roadway Grade Uphill
Roadway Surface Type Blacktop, Bituminous, or Asphalt
Roadway Surface Condition Dry
Traffic Control Device No Controls
Traffic Control Device Functioning No Controls
Pre Event Movement Negotiating a Curve
Critical Precrash Event THIS VEHICLE LOSS OF CONTROL DUE TO: Other Cause of Control Loss
Attempted Avoidance Maneuver Unknown/Not Reported
Precrash Stability Skidding Laterally - Clockwise Rotation
Pre-impact Location Departed Roadway
Crash Type No Impact
Vehicle Related Factor None Noted
Driver Related Factor Trailer Fishtailing or Swaying
Driver Related Factor Tire Blow-Out or Flat
Driver Related Factor Over Correcting
Visibility Obstructions No Obstruction Noted
Moving Violations None
Driver Maneuvered to Avoid Reported as Unknown
Vehicle Factors Tires
Damaged Areas 1 O'Clock
Damaged Areas 2 O'Clock
Damaged Areas 3 O'Clock
Damaged Areas 4 O'Clock
Damaged Areas 5 O'Clock
Damaged Areas 6 O'Clock
Damaged Areas 7 O'Clock
Damaged Areas 8 O'Clock
Damaged Areas 9 O'Clock
Damaged Areas 10 O'Clock
Damaged Areas 11 O'Clock
Damaged Areas 12 O'Clock
Damaged Areas Top
Damaged Areas Undercarriage
Driver Distracted Reported as Unknown if Distracted
Driver Impaired Reported as Unknown if Impaired
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Crash Events

Event #1 Event #1
VehicleVehicle #1
Area Of ImpactNon-Collision
Sequence of EventsCargo/Equipment Loss, Shift, or Damage (Harmful)
Event #2 Event #2
VehicleVehicle #1
Area Of ImpactNon-Harmful Event
Sequence of EventsRan off Road - Right
Event #3 Event #3
VehicleVehicle #1
Area Of ImpactNon-Collision
Sequence of EventsRollover/Overturn
Event #4 Event #4
VehicleVehicle #1
Area Of ImpactNon-Harmful Event
Sequence of EventsSeparation of Units
Event #5 Event #5
VehicleVehicle #1
Area Of ImpactNon-Collision
Sequence of EventsFire/Explosion

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