An 86-year-old Californian grandmother, who was the oldest woman to compete in Monday's New York Marathon, died a day later.
Joy Johnson from San Jose took just under eight hours to complete the race.
She stumbled and hit her head at around the 32-kilometre mark but went to the medical tent only after completing the race and declined their insistence that she go to hospital.
She returned to her hotel and lay down to rest and never woke up.
Monday's race was the 25th consecutive time the former PE teacher had finished the race.