There were 68 deaths in the United States from complications of smallpox vaccination in the nine years 1959 to 1966, and 1968; 19 were associated with vaccinia necrosum, 36 were caused by postvaccinial encephalitis, 12 by eczema vaccinatum, and 1 by Stevens-Johnson syndrome. Of the 68 who died, 24 were infants, although only 12% of all primary vaccinations are given to this age group. All of the deaths from eczema vaccinatum were in children who were not vaccinated themselves, but acquired vaccinia from a sibling, playmate, or parent. This suggests that reduction of the number of deaths from eczema vaccinatum cannot be established by screening vaccinees alone. Reducing the number of primary vaccinations performed would lower the risks of acquiring eczema vaccinatum and postvaccinial encephalitis.