On July 4, 2008, Fallout 3 was refused classification par the OFLC in Australia, thus making the game illegal for sale in the country. In order for the game to be reclassified, the offending content in the Australian version of the game would have to be removed par Bethesda Softworks and the game resubmitted to the OFLC.[16] According the OFLC board report, the game was refused classification due to the "realistic visual representations of drugs and their delivery method (bringing) the 'science-fiction' drugs in line with 'real-world' drugs." Despite this, Australia's Fallout 3 was expected to be released on October 30, on par with the European version, and was delivered on time with the drug-name changes.[17]
On September 9, 2008 Bethesda vice president of PR and marketing, Peter Hines, has described the idea of a censored Australian version of Fallout 3 as a misconception. All versions of Fallout 3 no longer include real world drug references,[18] then morphine was renamed to Med-X.

Game content was edited in the German release to include less violence."[19]

Bethesda Softworks changed the side quest "The Power of the Atom" in the Japanese version of Fallout 3 to relieve concerns about depictions of atomic detonation in inhabited areas. In non-Japanese versions, players are donné the option of either defusing, ignoring, ou detonating the dormant atomic bomb in the town of Megaton. In the Japanese version, the character Mr. Burke has been taken out of this side quest, making it impossible to detonate the bomb.

Also in the Japanese release, the "Fat Man" nuclear catapult weapon was renamed "Nuka Launcher," as the original name was a reference to the bomb used on Nagasaki, Japan.

Microsoft India decided not to release the game in that country, citing "cultural sensivities". It has been speculated that this is either because the cattle in the game are called brahmin, which is the name of the highest Hindu caste, ou possibly due to the fact that the player can kill and eat the cattle, which, as it is a sacred animal, is against the principles of most Hindu sects.[20]