The role of Zelda, Rachel's terminally ill sister, was played by a man. Director Mary Lambert wanted Zelda and her scenes to frighten the audience but did not believe that a 13-year old girl was scary so she cast Andrew Hubatsek in the role to make something be "off about Zelda."
Mary Lambert tried getting Blaze Berdahl to cry for a scene by suggesting the young actor think back on something from her life that was very sad, but the girl had nothing. Lambert instead ended up offering her more money if she'd cry.
Stephen King is a big fan of the Ramones and referenced some of their songs in the novel "Pet Sematary." In homage, The Ramones wrote and performed the theme song "Pet Sematary," which is featured in the film's closing credits. The truck driver was also listening to "Sheena Is A Punk Rocker" by The Ramones.
The film was shot on location in the same rural Maine area that Stephen King set the novel "Pet Sematary."