Mike Mussina pitched three shutout innings before allowing a leadoff single to Manny Ramirez in the fourth, when the Red Sox began to flex their muscles.

In the bottom of the inning, Wakefield walked Jason Giambi and Bernie Williams before being relieved by Alan Embree, who allowed an RBI double to Posada and sacrifice fly to Matsui to make it 5-2 Boston.

In the bottom of the inning, Derek Lowe issued a leadoff walk to Jorge Posada and one out later, Nick Johnson's home run put the Yankees up 2-1.

Next inning, Lowe allowed three consecutive one-out singles, the last of which, by Bernie Williams, scored Derek Jeter to make it 3-1 Yankees.

After a 13-minute delay, during which Fenway Park stopped all beer sales for the remainder of the game, Clemens struck out Ramirez and proceeded to pitch effectively as the Yankees held a lead.

The game did not end quietly: a Fenway groundskeeper got into a scuffle with Yankee reliever Jeff Nelson and Garcia in the middle of the 9th inning in the bullpen area.

In the top of the fifth, Tim Wakefield allowed back-to-back one-hit singles before Jeter's double tied the game and put runners on second and third.

They made it 4–1 in the eighth when Bernie Williams reached on a force out at second, moved to third on Posada's single and scored on Matsui's groundout off Alan Embree.

In the bottom of the inning, Todd Walker hit a leadoff triple off Mariano Rivera and scored on Garciaparra's groundout to make it 4-2 Yankees.

In the bottom of the fourth, Posada and Matsui hit back-to-back one-out singles before Nick Johnson's double and Aaron Boone's groundout scored a run each.

Garciaparra's error allowed Garcia to reach base before Soriano's two-run double put the Yankees on top, 5-4, and ended Burkett's night.

After allowing a one-out single to Bill Mueller, Contreras was relieved by Félix Heredia, who struck out Trot Nixon, but threw a wild pitch that put runners on second and third.

Thursday, October 16, 2003 at Yankee Stadium (I) in Bronx, New York In the Martinez–Clemens rematch of Game 3, Clemens allowed a one-out single to Millar before Nixon's home run put Boston up 2-0.

After Mueller struck out, Varitek doubled and scored on third baseman Enrique Wilson's throwing error to first on Damon's ground ball.

In the first relief appearance of his career, Mike Mussina cleaned up Clemens's mess by striking out Varitek and inducing a Johnny Damon double play.

But in the eighth inning, with the Red Sox leading 5–2 after Ortiz homered in the top half off David Wells, things unraveled for Boston.

[1] Little had two relievers who had shown effectiveness in the games leading up to the seventh game—Scott Williamson and Mike Timlin (who had not allowed a single hit in the playoffs),[1] but both had experienced stretches of ineffectiveness during the season, while Martínez had Hall of Fame credentials.

[1] To the surprise of many, Little left Martínez in the game, leaving lefty Alan Embree in the bullpen with the left-handed Matsui coming to the plate.

On Wakefield's first pitch of the inning, Boone launched a walk-off home run into the left field seats, sending the Yankees to the World Series.

Fox Sports displayed a collection of images thereafter: tears welling up in the eyes of Aaron's brother, Seattle Mariners infielder Bret Boone (the guest announcer), ALCS MVP Rivera running to the mound and collapsing on it in joy, Boone jumping on home plate, and Rivera being carried off on his teammates' shoulders.

[1] In his book Now I Can Die in Peace, Bill Simmons writes that the Boston owners and Theo Epstein had ordered Little to remove Martínez from the game when he finished the seventh inning and/or topped the three-digit pitch count.

[1] Others have noted that by staying with a physically fragile pitcher in an ultimate game with two runners on base, a three-run lead, a rested pitcher who had performed well in the postseason ready in the bullpen and the other team's MVP on deck, Little did exactly what Hall of Fame manager Walter Alston did with Sandy Koufax in Game 7 of the 1965 World Series, which Alston's Dodgers won.

Produced by National Hockey League Hall of Fame player Mark Messier in 2024, Amazon Prime spotlighted the 2003 ALCS in their series documentary 'Game 7'.