Essentials Reports on recurrence and mortality after a first venous thromboembolism (VTE) vary considerably. We describe rates of recurrence and mortality in patients with a first VTE from the Tromsø study. The overall recurrence rate was 3.9 per 100 person‐years, but this varied widely with time. Despite advances in VTE management, the rates of adverse events are still fairly high. Summary Background Previous reports on recurrence and mortality rates after a first episode of venous thromboembolism (VTE) vary considerably. Advances in the management and treatment of VTE during the last 15 years may have influenced the rates of clinical outcomes. Aim To estimate the rates of recurrence and mortality after a first VTE in patients recruited from a large population‐based cohort. Method From the Tromsø study, patients (n = 710) with a first, symptomatic, objectively confirmed VTE were included and followed in the period 1994–2012. Recurrent episodes of VTE were identified from multiple sources and carefully validated by review of medical records. Incidence rates and cumulative incidence rates with 95% confidence intervals (CIs) of VTE recurrence and mortality were calculated. Results The mean age of the patients was 68 years (range 28–102 years), and 166 (23.4%) had cancer at the time of first VTE. There were 114 VTE recurrences and 333 deaths during a median study period of 7.7 years (range 0.04–18.2 years). The risk of recurrence was highest during the first year. The overall 1‐year recurrence rate was 7.8 (95% CI 5.8–10.6) per 100 person‐years (PY), whereas the recurrence rate in the remaining follow‐up period (1–18 years) was 3.0 (95% CI 2.4–3.8) per 100 PY. The overall 1‐year all‐cause mortality rate was 29.9 (95% CI 25.7–34.8) per 100 PY, and in those without cancer the corresponding rate was 23.6 (95% CI 17.8–31.3) per 100 PY. Conclusion Despite advances in VTE management, the rates of adverse events remained fairly high, particularly in the first year following a first VTE.