A fatal case of tetanus occurred in 1991 in an 80 year old woman in Ohio. She sought treatment in the emergency department of a hospital due to a stiff jaw and dysphagia. She had slightly slurred speech and difficulty opening her mouth, but no difficulty breathing. She had an erythematous draining wound on her shin from a wood splinter from a forsythia bush. Treatment included tetanus immune globulin and tetanus toxoid, plus intravenous clindamycin. During the ensuing 2 week period she was treated for tremors, muscle spasms, abdominal rigidity, apnea, pneumonia, and local infection. She died 2 weeks after admission. An editorial note discussed age factors and vaccination status in tetanus cases. It urged that internists, family practitioners, occupational physicians and other primary health care providers who treat adults use every opportunity to review the vaccination status of their patients and vaccinate against tetanus as appropriate. This patient had come into contact with numerous persons in the health care system, yet she had no history of any vaccinations ever against tetanus.