The biggest risk for MDMA is serotonin syndrome, in my view. I got that a couple of years ago when I took a second cap on the comedown of my first. I became extremely overheated, drenched in sweat, my heart pounding, dizzy and started throwing up. I wasn't dancing or anything.
I immediately took an Uber home and sat in a cold shower and slowly ate some sorbet to cool down.
The next day I lay in bed with the fan going and barely moved. Every time I walked anywhere, slowly, my heart raced and I started panting.
I was lucky that I recognised the symptoms. Now I will never take more than 1 cap of MDMA at a time.