The capability to ensure reliability while operating in extreme environments is important for the most demanding automotive applications. Even though pressure sensors are a well-established area in the MEMS industry, improvements in sensor design are needed to deliver reliability and long operational life. This paper reports the design, fabrication and testing of a harsh media backside absolute piezoresistive pressure sensor. The device, which is fabricated with CMOS-MEMS processes, has been qualified using AEC-Q100 Grade 0 (Automotive Electronics Council) industry standards. The new sensor design provides excellent linearity, low temperature hysteresis and outstanding stability at operating temperatures from −40C to +150C.