A pen as an intermediate target becomes a secondary projectile

Firearm projectiles striking intermediate targets have the potential to create secondary projectiles, which can produce identifiable patterns of injury. We present a case in which a father, manipulating a handgun, was demonstrating how the firing pin worked to his adolescent son. He placed a pen inside the barrel of the gun for demonstration but did not recognize that a bullet was loaded into the firing chamber. The weapon was discharged causing fatal injury to the son. The pen, as an intermediate target, created identifiable injuries on the decedent, which were consistent with typical patterns of injury seen with secondary projectiles including a discrepant number of skin defects to number of counted projectiles and pseudo-stippling. Recognition of these identifiable patterns of injury in intermediate target involved gunshot wound cases can help support other autopsy findings and scene investigation.