Of the 3.3 of every 1000 persons in the United States who use a wheelchair, an estimated 3.3% per year have a serious wheelchair-related accident. Yet, only isolated case reports of fatal accidents have appeared. To obtain a better estimate of the incidence and nature of fatal accidents, a search was carried out of the death certificate database (1973-1987) of the National Information Clearinghouse of the Consumer Product Safety Commission; 770 wheelchair-related deaths were identified. The majority, 596 persons (77.4%), experienced a fall from their chairs or tipped over. Of 85 deaths (11%) caused by environmental factors, stairs were implicated in 51 (60.0%). Of 48 fatal burns (6.2%), 27 (57.3%) were related to smoking. Asphyxia owing to restraints occurred in 44 persons (5.7%) of all ages and caused 10 of the 17 deaths (58.8%) among persons 1-20 yr old. Wheelchair-related accidental death is uncommon (about 0.2% of serious accidents per year), but some types of accidents appear to be preventable.