"100 Tears" was slapped with an NC-17 rating for extreme horror violence, and it's not hard to understand what that means once you watch the movie. Less than 20 minutes in, a man's head has been split in half by a giant axe, wielded by Gurdy the Clown (Jack Amos). The camera captures it all in a closeup shot.
Director Marcus Koch revealed in the aforementioned 2009 interview with the Dead Harvey blog that the intensity of the kills was a way to keep his killer clown actually scary and avoid any humor that may come for some in seeing a serial killer clown. This is also why he kept Gurdy dialogue-free through the film. As he explained, "I absolutely didn't want a killer clown to spit out silly, witty one liners or do anything clown-like, like kill someone with balloon animals or a deadly pie to the face. I thought it would be good to have a silent killer, I think it's always been a good idea. Imagine how bad it would be if Jason or [Michael] Myers spoke?" the director said.
The NC-17 rating for "100 Tears" does put it in a class with some fairly legendary pictures,1981's "The Evil Dead," which kicked off one of the biggest horror franchises of all-time.