Alexander VIII's great-nephew, Cardinal Pietro Ottoboni, commissioned this tomb monument to be built. Carlo Enrico di San Martino was the designer of the tomb, and its sculptor was Angelo de' Rossi. The tomb bears a great resemblance to, and was inspired by, the tomb monument of Pope Urban VIII, created by Gian Lorenzo Bernini. The figures standing at the base of the monument in the medal give an idea as to the scale of the tomb.

The purpose of the medal is clearly twofold: to honor the deceased pontiff (d. 1691) and to, in essence, "show off" the monument being constructed for the tomb by his nephew. Being commissioned by the pope's nephew, Cardinal Pietro Ottoboni, it is not surprising that the obverse inscription remembers the late pontiff not only for his ecclesiastical role, but also as a member of the proud Ottoboni family from Venice. The reverse inscription around the design also makes clear that the tomb is a gift from the cardinal-nephew.

Though Cardinal Ottoboni had hoped to have the monument completed (or at least, enough completed to allow for the transfer of the pope's remains to it) by the Holy Year of 1700 (as indicated by the date on the medal), this transfer was not possible until 1706. Research by Olszewski indicates that the medals were originally struck in 1706, based on a contract found in the Ottoboni archives indicating an order of 2 gold medals, 103 silver medals, and 466 copper medals. This contract does not indicate whom the medallist is, but Olszewski supports that it refers to this medal. The tomb was not completed until 1725, and the medal represents the intended design based on plans available to Saint-Urbain at the time of engraving, and not the final design.