Film historian and critic Roberto Curti stated that the according to the Public Cinematographic Register, filming was published as beginning on March 24, but it was more likely that filming had not begun until April 1980. Shooting schedule allowed for shooting on location in both New York City and six weeks shot in Savannah, Georgia, and two weeks in Rome at De Paolis Studios for the special effects scenes. Among the special effects scenes included a scene where the cast is attacked by maggots via two wind machines and a 10 kg of maggots. To surprise Fulci, one crew member took some of the maggots and placed them in his pipe tobacco which Fulci only learned after a few puffs of what he was smoking, angering him immensely. Fulci would later theorize that this incident led to his future illness as he went for heart surgery in 1985, suffered a ventricular aneurysm, contracted viral hepatitis and developed Cirrhosis of the liver. Many of the film's gory and graphic scenes were not included in the original scripts or story, such as the scene where a character vomits their own intestines is absent. This scene was performed by having the Daniela Doria spit up baby veal intestines, and then having her head replaced with replica for further vomiting. "City of the Living Dead" was distributed theatrically in Italy by Medusa Distribuzione on 11 August 1980. It grossed a total of 985,238,798 Italian lire domestically, a figure described by Curti as "somewhat disappointing". The film was distributed theatrically through Europe, including West Germany on September 11, 1980, France on December 10, 1980 as well as the Netherlands, Spain and Portugal. The German edit of the film distributed by Alemannia/Arabella was about 10 minutes shorter than the Italian version, removing some dialogue scenes but keeping the gory scenes intact. In Paris, the film was screened as "Frayeurs" at the "Festival international du film et de science-fiction". At the festival, the film won the "Grand Prix du Public" (The Audience Award). The film was released in the United Kingdom on May 7, 1982, where it was passed by the BBFC after the drilling scene was cut. In the United States, the film was released on 8 April 1983, and was originally promoted as "Twilight of the Dead", which resulted in a cease and desist order from United Film Distribution Company due to the title's similarity to their own film, George A. Romero's "Dawn of the Dead".