ABSTRACT Despite successful large-scale immunization programs in North America, there remains a significant population without active immunity to tetanus toxins because immunizations have been refused or delayed, and because of waning immunity. We report the case of a 7-year-old boy who presented to the emergency department with a chin laceration and a 7-day history of repeated falls of increasing frequency. We found this case to be associated with dysphagia and facial spasm, and we learned that the child had dropped a brick on his foot 2 weeks previously. The patient was subsequently diagnosed with tetanus and treated accordingly. Tetanus presentations to emergency departments may vary from mild muscular rigidity to advanced respiratory failure and thus clinicians should consider the diagnosis in various clinical presentations, especially in areas remote from advanced supportive care.