Jake Kimble (the only survivor from the second film) is under the care of Dr. Sullivan in an asylum. He is locked in his room following several escape attempts and is attacked by Kayako. The attack is seen on security cameras, although Kayako cannot be seen, and Jake is dead by the time Sullivan arrives with a security officer. News of the incident reaches a young woman in Tokyo, Naoko, who is the sister of Kayako. Believing that her sister is responsible, she travels to Chicago.