Tennessee State medical examiner reports of firearm fatalities classified as accidents involving victims aged 19 year or less from 1961 through 1988, were reviewed to evaluate circumstantial and contributing factors. A total of 225 were analyzed. The peak age for victims was 17 years, and there were more than five times more male than female victims. In Shelby County (Memphis), the racial distribution of fatalities was approximately that of the general population. Playing with a gun was the most frequent circumstance. The person responsible for pulling the trigger was equally likely to be a friend, a family member, or the victim. Head or neck were injured in most cases. The urban mortality rate was nearly twice that of the rural rate. More than half of the deaths in urban counties occurred indoors and involved handguns, whereas in rural counties only a third were due to handguns and the location was more often outdoors. Deaths in rural counties showed a seasonal variation that corresponded with the hunting season; by contrast, a peak in early summer was noted in the urban deaths. Defective guns or guns unsafe in design caused several deaths. (Semiautomatic pistols, which can be fired after unloading the ammunition magazine, are conspicuous examples of guns unsafe in design.) An important observation of this study is that medical examiners vary considerably in their classification of accidental manner, particularly when children are involved. Furthermore, medical examiner reports need to include much more information than is currently recorded if they are to be useful in guiding public policy to reduce firearm injuries.