You repeatedly strike the tuning fork against the vial once per six seconds for sixty minutes, resulting in six hundred strikes. On the six-hundredth strike, roll a d20.
1: You are vaporized in a massive fireball that consumes and disintegrates everything within a ten-mile radius, destroying everything that is not an artifact.
2: You and everything, including creatures, objects, the terrain, any magical effects, and the air, in a fifteen mile radius are transported, unharmed, into a random Lower or Outer Plane. A similarly-sized chunk of the selected Lower or Outer Plane replaces the area.
3: All magic in the world stops working for 1d6 days, and you become the first to die of an extremely viral plague that melts the insides of any infected creature with no hope of recovery. All magical items, even artifacts, become mundane for the duration, but cannot be destroyed. The suppressed spells are returned, with their duration paused, after the effect ends.
4: You and everything within a ten-mile radius are completely removed from the timeline, as if you never existed. All memory of you and the area is wiped from the minds of all the multiverse, all possessions and creations of creatures inside the sphere cease to exist, and any paternal or maternal connections cease to exist along with any descendants. Any creature with history within the sphere, but that is not actively within it, has that history relocated as to not break the timeline. All history is adjusted to never include that area.
5: A massive asteroid changes direction and strikes a random spot on the current plane. Everything within a hundred miles of the impact site that is not within a reinforced bunker is instantly wiped off the face of the plane. The climate of the plane gets two steps colder for the next 50 years. Crops mostly fail for the next 15 years, and the sun is blotted out for the next 5.
6: The avatar of a random, Evil god appears at your location and sunders you and the nearby area from existence in short order before going on a destructive rampage for 1d4 weeks.
7: For 1d6 hours, all sapient creatures in the plane become Chaotic Evil and anarchy reigns.
8: Large and small factions alike align themselves with pacts of varying size. Within five years, every single pact will be at war with every single other one.
9: An extradimensional vault opens a portal atop you, instantly killing you before unleashing legions of voracious apex predators, ruthless killing machines, or a nigh-omnipotent, vengeful demigod into the world.
10: Every volcano in the world erupts simultaneously, producing an effect similar to the asteroid's climate effect.
11: A hyper-advanced alien civilization, superintelligent AI, cosmic entity, voracious hive mind, or star god, all from the depths of outer space, turns its attention to your part of the universe. Prepare for an invasion.
12: Two of the largest civilizations in the world rapidly advance through time to the possession of anachronistic weapons, such as firearms, armored vehicles, jet fighters, and nuclear weapons. Things then progress as by an '8' result. The two civilizations will always oppose one another in the war.
13: The plane is briefly sundered in two, causing everything within a 5-mile-thick line that spans the entire plane to be instantly destroyed.
14: A massive blight spreads into every corner of the known world, causing complete crop failure for 1d4 years. Famine will ensue.
15: Two enormous star civilizations wage war on one another, and your planet becomes a massive battlefield.
16: The entire population of the plane becomes heavily dependent on a veritable wonder-drug, and society collapses when the stores run out.
17: All members of a random, non-mundane race suddenly drop dead.
18: A significant portion of the world population is enslaved under a new, brutal warlord.
19: A Good god brings their faithful to paradise, or an Evil god drags a massive number of innocent souls to the Underworld.
20: Roll three more times. If 20 appears again, roll once more. If there is another 20, the world is set upon by the absolute worst outcomes of all 19 events.
If you are interrupted in the middle of the spell, every god and entity in existence will be set after you, and you will be dragged into a demiplane where you are chained down with bonds stronger than adamantine, and a new form of torture that even the Devils would balk at is devised every minute just for you, for all eternity, with no hope of escape. While casting this spell, all sapient creatures in the world feel a deep, primal sense of foreboding, all animals appear visibly distressed, any sleeping creatures are plagued by nightmares, and psychics and mediums have a chance to be driven violently insane. All Sorcerers, Clerics, Paladins, Wizards, and Artificers in the world immediately become aware of your position, and, knowing what you are about to do, even if you cast the spell successfully, will hunt you to the ends of the earth. All magic in the world flickers as you cast this spell except for magic within 50 miles of you, which is overcharged, behaving as if it was cast three levels higher.
You truly must be insane to cast this spell.
* - (a vial of pure hellfire mixed with the spilled ichor of a dead god, a tuning fork made of adamantine, and a holy/unholy symbol made of the most valuable materials in all the land)
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