diff --git a/lib/towerops/alerts.ex b/lib/towerops/alerts.ex
index d2069274..b2f4d717 100644
--- a/lib/towerops/alerts.ex
+++ b/lib/towerops/alerts.ex
@@ -215,21 +215,41 @@ defmodule Towerops.Alerts do
   Acknowledges an alert.
   """
   def acknowledge_alert(alert, user_id) do
-    alert
-    |> Alert.changeset(%{
-      acknowledged_at: DateTime.truncate(DateTime.utc_now(), :second),
-      acknowledged_by_id: user_id
-    })
-    |> Repo.update()
+    result =
+      alert
+      |> Alert.changeset(%{
+        acknowledged_at: DateTime.truncate(DateTime.utc_now(), :second),
+        acknowledged_by_id: user_id
+      })
+      |> Repo.update()
+
+    case result do
+      {:ok, updated_alert} ->
+        Task.start(fn -> Towerops.PagerDuty.Notifier.notify_acknowledge(updated_alert) end)
+        {:ok, updated_alert}
+
+      error ->
+        error
+    end
   end
 
   @doc """
   Resolves an alert.
   """
   def resolve_alert(alert) do
-    alert
-    |> Alert.changeset(%{resolved_at: DateTime.truncate(DateTime.utc_now(), :second)})
-    |> Repo.update()
+    result =
+      alert
+      |> Alert.changeset(%{resolved_at: DateTime.truncate(DateTime.utc_now(), :second)})
+      |> Repo.update()
+
+    case result do
+      {:ok, updated_alert} ->
+        Task.start(fn -> Towerops.PagerDuty.Notifier.notify_resolve(updated_alert) end)
+        {:ok, updated_alert}
+
+      error ->
+        error
+    end
   end
 
   @doc """
diff --git a/lib/towerops/integrations/integration.ex b/lib/towerops/integrations/integration.ex
index cd95a041..f40b480f 100644
--- a/lib/towerops/integrations/integration.ex
+++ b/lib/towerops/integrations/integration.ex
@@ -14,7 +14,7 @@ defmodule Towerops.Integrations.Integration do
   @primary_key {:id, :binary_id, autogenerate: true}
   @foreign_key_type :binary_id
 
-  @valid_providers ~w(preseem gaiia)
+  @valid_providers ~w(preseem gaiia pagerduty)
   @valid_sync_statuses ~w(never success partial failed)
 
   schema "integrations" do
diff --git a/lib/towerops/pagerduty/client.ex b/lib/towerops/pagerduty/client.ex
new file mode 100644
index 00000000..42e7564a
--- /dev/null
+++ b/lib/towerops/pagerduty/client.ex
@@ -0,0 +1,112 @@
+defmodule Towerops.PagerDuty.Client do
+  @moduledoc "PagerDuty Events API v2 client."
+
+  require Logger
+
+  @events_url "https://events.pagerduty.com/v2/enqueue"
+
+  def trigger(routing_key, alert, device, site_name, towerops_url) do
+    send_event(%{
+      routing_key: routing_key,
+      event_action: "trigger",
+      dedup_key: dedup_key(alert),
+      payload: %{
+        summary: alert_summary(alert, device),
+        source: "towerops",
+        severity: severity(alert.alert_type),
+        timestamp: DateTime.to_iso8601(alert.triggered_at),
+        component: device.hostname || device.ip_address,
+        group: site_name,
+        class: to_string(alert.alert_type),
+        custom_details: %{
+          device_id: device.id,
+          device_name: device.hostname || device.ip_address,
+          ip_address: device.ip_address,
+          site_name: site_name,
+          alert_type: to_string(alert.alert_type),
+          message: alert.message,
+          towerops_url: towerops_url
+        }
+      },
+      links: [%{href: towerops_url, text: "View in TowerOps"}]
+    })
+  end
+
+  def acknowledge(routing_key, alert) do
+    send_event(%{
+      routing_key: routing_key,
+      event_action: "acknowledge",
+      dedup_key: dedup_key(alert)
+    })
+  end
+
+  def resolve(routing_key, alert) do
+    send_event(%{
+      routing_key: routing_key,
+      event_action: "resolve",
+      dedup_key: dedup_key(alert)
+    })
+  end
+
+  def test_connection(routing_key) do
+    test_dedup = "towerops-test-#{System.unique_integer([:positive])}"
+
+    case send_event(%{
+           routing_key: routing_key,
+           event_action: "trigger",
+           dedup_key: test_dedup,
+           payload: %{
+             summary: "TowerOps integration test",
+             source: "towerops",
+             severity: "info",
+             timestamp: DateTime.to_iso8601(DateTime.utc_now())
+           }
+         }) do
+      {:ok, _} ->
+        send_event(%{
+          routing_key: routing_key,
+          event_action: "resolve",
+          dedup_key: test_dedup
+        })
+
+      error ->
+        error
+    end
+  end
+
+  defp send_event(body) do
+    case Req.post(@events_url, json: body) do
+      {:ok, %{status: status, body: resp_body}} when status in [200, 202] ->
+        {:ok, resp_body}
+
+      {:ok, %{status: 400, body: resp_body}} ->
+        {:error, {:bad_request, resp_body["message"] || "Invalid event"}}
+
+      {:ok, %{status: 429}} ->
+        {:error, :rate_limited}
+
+      {:ok, %{status: status}} ->
+        {:error, {:unexpected_status, status}}
+
+      {:error, error} ->
+        Logger.warning("PagerDuty API error: #{inspect(error)}")
+        {:error, error}
+    end
+  end
+
+  defp dedup_key(alert), do: "towerops-alert-#{alert.id}"
+
+  defp alert_summary(alert, device) do
+    name = device.hostname || device.ip_address
+
+    case alert.alert_type do
+      :device_down -> "Device down: #{name}"
+      :device_up -> "Device recovered: #{name}"
+      other -> "Alert: #{other} on #{name}"
+    end
+  end
+
+  defp severity(:device_down), do: "critical"
+  defp severity(:device_up), do: "info"
+  defp severity(_), do: "warning"
+end
diff --git a/lib/towerops/pagerduty/notifier.ex b/lib/towerops/pagerduty/notifier.ex
new file mode 100644
index 00000000..4909dccb
--- /dev/null
+++ b/lib/towerops/pagerduty/notifier.ex
@@ -0,0 +1,84 @@
+defmodule Towerops.PagerDuty.Notifier do
+  @moduledoc "Sends alert events to PagerDuty when integration is configured."
+
+  alias Towerops.Integrations
+  alias Towerops.PagerDuty.Client
+  alias Towerops.Repo
+
+  require Logger
+
+  def notify_trigger(alert, device) do
+    with {:ok, routing_key} <- get_routing_key(device.organization_id) do
+      site_name = get_site_name(device)
+      towerops_url = device_url(device)
+
+      case Client.trigger(routing_key, alert, device, site_name, towerops_url) do
+        {:ok, _} ->
+          Logger.info("PagerDuty incident triggered for alert #{alert.id}")
+          :ok
+
+        {:error, reason} ->
+          Logger.warning("PagerDuty trigger failed for alert #{alert.id}: #{inspect(reason)}")
+          :error
+      end
+    end
+  end
+
+  def notify_acknowledge(alert) do
+    alert = Repo.preload(alert, device: :site)
+
+    with {:ok, routing_key} <- get_routing_key(alert.device.organization_id) do
+      case Client.acknowledge(routing_key, alert) do
+        {:ok, _} ->
+          Logger.info("PagerDuty incident acknowledged for alert #{alert.id}")
+          :ok
+
+        {:error, reason} ->
+          Logger.warning(
+            "PagerDuty acknowledge failed for alert #{alert.id}: #{inspect(reason)}"
+          )
+
+          :error
+      end
+    end
+  end
+
+  def notify_resolve(alert) do
+    alert = Repo.preload(alert, device: :site)
+
+    with {:ok, routing_key} <- get_routing_key(alert.device.organization_id) do
+      case Client.resolve(routing_key, alert) do
+        {:ok, _} ->
+          Logger.info("PagerDuty incident resolved for alert #{alert.id}")
+          :ok
+
+        {:error, reason} ->
+          Logger.warning("PagerDuty resolve failed for alert #{alert.id}: #{inspect(reason)}")
+          :error
+      end
+    end
+  end
+
+  defp get_routing_key(organization_id) do
+    case Integrations.get_integration(organization_id, "pagerduty") do
+      {:ok, %{enabled: true, credentials: %{"api_key" => key}}} when key != "" ->
+        {:ok, key}
+
+      _ ->
+        {:error, :not_configured}
+    end
+  end
+
+  defp get_site_name(device) do
+    device = Repo.preload(device, :site)
+
+    case device.site do
+      nil -> "Unknown Site"
+      site -> site.name
+    end
+  end
+
+  defp device_url(device) do
+    ToweropsWeb.Endpoint.url() <> "/devices/#{device.id}"
+  end
+end
diff --git a/lib/towerops/workers/device_monitor_worker.ex b/lib/towerops/workers/device_monitor_worker.ex
index e88bf8f6..ba25d396 100644
--- a/lib/towerops/workers/device_monitor_worker.ex
+++ b/lib/towerops/workers/device_monitor_worker.ex
@@ -202,7 +202,7 @@ defmodule Towerops.Workers.DeviceMonitorWorker do
   defp create_device_down_alert(device, now) do
     alert_message = get_down_alert_message(device)
 
-    {:ok, _alert} =
+    {:ok, alert} =
       Alerts.create_alert(%{
         device_id: device.id,
         alert_type: :device_down,
@@ -210,6 +210,8 @@ defmodule Towerops.Workers.DeviceMonitorWorker do
         message: alert_message
       })
 
+    Task.start(fn -> Towerops.PagerDuty.Notifier.notify_trigger(alert, device) end)
+
     _ =
       Phoenix.PubSub.broadcast(
         Towerops.PubSub,
@@ -229,7 +231,7 @@ defmodule Towerops.Workers.DeviceMonitorWorker do
   defp handle_equipment_up(device, now) do
     recovery_message = get_recovery_message(device)
 
-    {:ok, _alert} =
+    {:ok, alert} =
       Alerts.create_alert(%{
         device_id: device.id,
         alert_type: :device_up,
@@ -237,6 +239,8 @@ defmodule Towerops.Workers.DeviceMonitorWorker do
         message: recovery_message
       })
 
+    Task.start(fn -> Towerops.PagerDuty.Notifier.notify_trigger(alert, device) end)
+
     resolve_down_alert(device)
 
     _ =
diff --git a/lib/towerops_web/live/help_live/index.ex b/lib/towerops_web/live/help_live/index.ex
index 8c2c7b20..c9dd1f0d 100644
--- a/lib/towerops_web/live/help_live/index.ex
+++ b/lib/towerops_web/live/help_live/index.ex
@@ -1756,6 +1756,83 @@ defmodule ToweropsWeb.HelpLive.Index do
                       </div>
                     </div>
 
+                    <h3 class="text-lg font-semibold text-gray-900 dark:text-white mt-8 mb-3">
+                      PagerDuty
+                    </h3>
+
+                    <p class="text-gray-600 dark:text-gray-400">
+                      <a href="https://www.pagerduty.com" class="underline hover:text-blue-900 dark:hover:text-blue-200 text-blue-700 dark:text-blue-300">PagerDuty</a>
+                      is an incident management and on-call alerting platform. The PagerDuty integration provides
+                      2-way alert sync — when a device goes down in Towerops, a PagerDuty incident is automatically
+                      triggered. Acknowledging or resolving the alert in Towerops updates the PagerDuty incident as well.
+                    </p>
+
+                    <h4 class="text-base font-semibold text-gray-900 dark:text-white mt-4 mb-2">
+                      How It Works
+                    </h4>
+
+                    <ul class="space-y-2 text-gray-600 dark:text-gray-400 list-disc list-inside">
+                      <li>Device goes down → PagerDuty incident triggered (critical severity)</li>
+                      <li>Alert acknowledged in Towerops → PagerDuty incident acknowledged</li>
+                      <li>Device recovers / alert resolved → PagerDuty incident resolved</li>
+                    </ul>
+
+                    <h4 class="text-base font-semibold text-gray-900 dark:text-white mt-4 mb-2">
+                      Configuration
+                    </h4>
+
+                    <div class="space-y-4">
+                      <div class="flex gap-4">
+                        <div class="flex-shrink-0">
+                          <div class="flex items-center justify-center w-8 h-8 rounded-full bg-blue-100 dark:bg-blue-900/50 text-blue-700 dark:text-blue-300 font-semibold">
+                            1
+                          </div>
+                        </div>
+                        <div class="flex-1">
+                          <h4 class="text-base font-semibold text-gray-900 dark:text-white mb-2">
+                            Create an Events API v2 Integration in PagerDuty
+                          </h4>
+                          <p class="text-sm text-gray-600 dark:text-gray-400">
+                            In PagerDuty, go to <.code>Services</.code> → select your service → <.code>Integrations</.code> tab → <.code>Add Integration</.code> → choose <.code>Events API v2</.code>. Copy the <.code>Integration Key</.code> (routing key).
+                          </p>
+                        </div>
+                      </div>
+
+                      <div class="flex gap-4">
+                        <div class="flex-shrink-0">
+                          <div class="flex items-center justify-center w-8 h-8 rounded-full bg-blue-100 dark:bg-blue-900/50 text-blue-700 dark:text-blue-300 font-semibold">
+                            2
+                          </div>
+                        </div>
+                        <div class="flex-1">
+                          <h4 class="text-base font-semibold text-gray-900 dark:text-white mb-2">
+                            Configure in Towerops
+                          </h4>
+                          <p class="text-sm text-gray-600 dark:text-gray-400">
+                            Navigate to <.code>Organization Settings</.code> → <.code>Integrations</.code> tab → click <.code>Configure</.code> on PagerDuty. Paste your integration key and test the connection.
+                          </p>
+                        </div>
+                      </div>
+                    </div>
+
+                    <div class="mt-4 p-4 bg-blue-50 dark:bg-blue-900/20 border border-blue-200 dark:border-blue-800 rounded-lg">
+                      <div class="flex gap-3">
+                        <.icon
+                          name="hero-information-circle"
+                          class="h-5 w-5 text-blue-600 dark:text-blue-400 flex-shrink-0 mt-0.5"
+                        />
+                        <div>
+                          <h4 class="text-sm font-semibold text-blue-900 dark:text-blue-300 mb-1">
+                            Event-Driven
+                          </h4>
+                          <p class="text-sm text-blue-800 dark:text-blue-300">
+                            Unlike other integrations, PagerDuty is event-driven — there is no periodic sync.
+                            Alerts are sent to PagerDuty in real time as they occur. No polling or sync interval is needed.
+                          </p>
+                        </div>
+                      </div>
+                    </div>
+
                     <h3 class="text-lg font-semibold text-gray-900 dark:text-white mt-8 mb-3">
                       General Integration Features
                     </h3>
diff --git a/lib/towerops_web/live/org/integrations_live.ex b/lib/towerops_web/live/org/integrations_live.ex
index 1df6bc6f..c5218c3c 100644
--- a/lib/towerops_web/live/org/integrations_live.ex
+++ b/lib/towerops_web/live/org/integrations_live.ex
@@ -22,6 +22,13 @@ defmodule ToweropsWeb.Org.IntegrationsLive do
       description:
         "Billing and subscriber management. Enables outage impact analysis, inventory reconciliation, and subscriber-aware monitoring.",
       icon: "hero-user-group"
+    },
+    %{
+      id: "pagerduty",
+      name: "PagerDuty",
+      description:
+        "Incident management and on-call alerting. Automatically triggers, acknowledges, and resolves PagerDuty incidents from TowerOps alerts.",
+      icon: "hero-bell-alert"
     }
   ]
 
diff --git a/lib/towerops_web/live/org/settings_live.ex b/lib/towerops_web/live/org/settings_live.ex
index 3576b410..de2427e3 100644
--- a/lib/towerops_web/live/org/settings_live.ex
+++ b/lib/towerops_web/live/org/settings_live.ex
@@ -26,6 +26,13 @@ defmodule ToweropsWeb.Org.SettingsLive do
       description:
         "Billing and subscriber management. Enables outage impact analysis, inventory reconciliation, and subscriber-aware monitoring.",
       icon: "hero-user-group"
+    },
+    %{
+      id: "pagerduty",
+      name: "PagerDuty",
+      description:
+        "Incident management and on-call alerting. Automatically triggers, acknowledges, and resolves PagerDuty incidents from TowerOps alerts.",
+      icon: "hero-bell-alert"
     }
   ]
 
@@ -395,6 +402,10 @@ defmodule ToweropsWeb.Org.SettingsLive do
 
   defp test_provider_connection("preseem", api_key), do: PreseemClient.test_connection(api_key)
   defp test_provider_connection("gaiia", api_key), do: GaiiaClient.test_connection(api_key)
+
+  defp test_provider_connection("pagerduty", api_key),
+    do: Towerops.PagerDuty.Client.test_connection(api_key)
+
   defp test_provider_connection(_, _api_key), do: {:error, "Unknown provider"}
 
   defp load_integrations(organization_id) do
diff --git a/lib/towerops_web/live/org/settings_live.html.heex b/lib/towerops_web/live/org/settings_live.html.heex
index 5d61d02b..774ffa86 100644
--- a/lib/towerops_web/live/org/settings_live.html.heex
+++ b/lib/towerops_web/live/org/settings_live.html.heex
@@ -840,6 +840,9 @@
                         <%= if provider.id == "gaiia" do %>
                           Syncs every {integration.sync_interval_minutes} minutes. Reconciliation runs nightly. Also receives real-time webhook updates.
                         <% end %>
+                        <%= if provider.id == "pagerduty" do %>
+                          Event-driven — alerts are sent to PagerDuty in real time when devices go down, are acknowledged, or recover.
+                        <% end %>
                       </p>
                     </div>
                   <% end %>
@@ -894,24 +897,32 @@
                 <.input
                   field={@integration_form[:api_key]}
                   type="password"
-                  label="API Key"
-                  placeholder={"Enter your #{provider.name} API key"}
+                  label={if(provider.id == "pagerduty", do: "Integration Key (Routing Key)", else: "API Key")}
+                  placeholder={if(provider.id == "pagerduty", do: "Enter your PagerDuty integration key", else: "Enter your #{provider.name} API key")}
                   autocomplete="off"
                   value={get_credential(@integrations[provider.id], "api_key")}
                 />
 
-                <.input
-                  field={@integration_form[:sync_interval_minutes]}
-                  type="number"
-                  label="Sync interval (minutes)"
-                  min="5"
-                  value={
-                    if(@integrations[provider.id],
-                      do: @integrations[provider.id].sync_interval_minutes,
-                      else: if(provider.id == "gaiia", do: 15, else: 10)
-                    )
-                  }
-                />
+                <%= if provider.id == "pagerduty" do %>
+                  <p class="text-xs text-gray-500 dark:text-gray-400 -mt-2">
+                    Find this in PagerDuty → Services → Your Service → Integrations → Events API v2
+                  </p>
+                <% end %>
+
+                <%= if provider.id != "pagerduty" do %>
+                  <.input
+                    field={@integration_form[:sync_interval_minutes]}
+                    type="number"
+                    label="Sync interval (minutes)"
+                    min="5"
+                    value={
+                      if(@integrations[provider.id],
+                        do: @integrations[provider.id].sync_interval_minutes,
+                        else: if(provider.id == "gaiia", do: 15, else: 10)
+                      )
+                    }
+                  />
+                <% end %>
 
                 <%= if @test_result do %>
                   <div class={[
diff --git a/test/towerops/pagerduty/client_test.exs b/test/towerops/pagerduty/client_test.exs
new file mode 100644
index 00000000..92f36ac1
--- /dev/null
+++ b/test/towerops/pagerduty/client_test.exs
@@ -0,0 +1,45 @@
+defmodule Towerops.PagerDuty.ClientTest do
+  use ExUnit.Case, async: true
+
+  alias Towerops.PagerDuty.Client
+
+  describe "trigger/5" do
+    test "builds correct event body" do
+      alert = %{
+        id: "abc-123",
+        alert_type: :device_down,
+        triggered_at: ~U[2024-01-15 10:30:00Z],
+        message: "Device is not responding to ping"
+      }
+
+      device = %{
+        id: "dev-456",
+        hostname: "router-01",
+        ip_address: "10.0.0.1",
+        organization_id: "org-789"
+      }
+
+      # We can't easily test the HTTP call without mocking,
+      # but we verify the function exists and accepts the right arity
+      assert is_function(&Client.trigger/5)
+    end
+  end
+
+  describe "acknowledge/2" do
+    test "accepts routing key and alert" do
+      assert is_function(&Client.acknowledge/2)
+    end
+  end
+
+  describe "resolve/2" do
+    test "accepts routing key and alert" do
+      assert is_function(&Client.resolve/2)
+    end
+  end
+
+  describe "test_connection/1" do
+    test "accepts routing key" do
+      assert is_function(&Client.test_connection/1)
+    end
+  end
+end