Two patients developed localized nodular reactions at the site of prior tetanus toxoid injections. Histology of the lesions showed granuloma formation with central granular debris surrounded by a histiocytic mantle. Peripheral to this was a dense lymphoid infiltrate with eosinophils. Examination with energy dispersive x-ray microanalysis confirmed the presence of aluminium and phosphorus in the granular debris but not in the surrounding infiltrate.