A teenager suffered horror injuries when an e-cigarette he was smoking exploded in his face.
The 17-year-old was left with a bloody mouth, broken teeth and a hole in his jaw after the explosion.
The boy then had to travel 250 miles from a small town in Nevada to a pediatric hospital in Utah with his mother.
There, doctors rushed him into surgery, working to reconstruct and repair shattered bone.
But the freak accident is just one of thousands in recent years, documented in a new case study on e-cigarettes which have become increasingly popular in recent years.
The teenager had no idea the vape could explode according to Dr Katie Russell, the trauma medical director at Primary Children's Hospital who first treated the boy.
He repeated the line over and over again in the emergency room, she remembers, and he was still "pretty freaked out" hours after the explosion.
"At that time, in my career, I had never seen this. I never heard of this as a possibility" said Russell, who described the boy's injuries in the New England Journal of Medicine.
"I just wanted to get this out there so other people could know that this was possible," she added.
The boy Russell treated was "a tough kid," she said, and he healed well.
It's unclear what type of e-cigarette was involved in the incident.
But others have not been so lucky.
In February, a Texas man died after his e-cigarette exploded and shrapnel tore through his carotid artery.
Part of the device remained lodged in the man's throat at the hospital, according to his family.
About a year ago, a Florida man was also found dead after his e-cigarette exploded during use, sending a projectile into his head.