>>717789179
Funny thing, it was E10 originally. When you release a game digital-only nobody reviews it, you just fill out a form clicking what is in the game, and many of the questions are subjective or worded in a rather vague way. Same reason the Tomb Raider I-III remakes were M rated at first.

Once it came time to go physical, there was blood in the game (pic related) that the dev either missed or figured didn't count as "blood" cause it's revealed to be staged 30 minutes later. The ESRB freaked out and bumped the rating up purely cause of this one scene.