Emergency departments (EDs) are the primary driver for hospital admissions in the United States (US), and that trend is likely to continue through the ongoing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. As the US continues to experience rampant community spread, coronavirus disease 2019 (COVID-19) will likely present in increasingly variable ways to the EDs. We present a case of Mallory-Weiss tear and esophageal perforation, which was likely caused by COVID-19 pneumonia. This case is notably the first of its kind that we have seen reported in the COVID-19-related literature. Clinicians should be vigilant about the various complications of COVID-19 and continue to exercise caution when seeing and treating these patients.