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Since 1977, the Purdue University Agricultural Safety and Health Program has managed a database with on going efforts to identify, document, and analyze information on injuries and fatalities in all forms of agricultural confined spaces, with special attention given to incidents involving grain, forage, and manure storage structures and agricultural transport vehicles. The database contains over 1650 cases from 1964 to the present and two cases before 1964. The average number of cases in the last ten years remains at a high of 63 cases per year. Overall, confined-space related cases were documented in 43 states, with the most occurring in the Corn Belt region. More than 1000 (62%) of these cases were grain-related entrapments; however, in recent years the proportion of grain-related cases has declined with more aggressive surveillance for all types of agricultural confined-space incidents including falls and entanglements inside grain storage structures. Grain entrapments represented 49% of all confined space cases in 2013 as compared to earlier years when nearly all documented cases were grain entrapment related. There has also been a shift in location distribution of cases, with the southern states now representing 18% of all recent cases. These findings are critical for informing the discussion on developing regulations, design standards, and safety programs to reduce the frequency and severity of these incidents.