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FDA Investigates Puffer Fish Poisoning Illness in Virginia

January 28, 2014

What is the Problem and What was Done About It?

The FDA and state and local officials investigated a case of tetrodotoxin poisoning in Fairfax County, Virginia which is believed to be linked to the consumption of imported puffer fish that was not processed and prepared by specially trained and certified fish cutters as part of an agreement between the U.S. and Japan.

The liver, gonads (ovaries and testes), intestines, and skin of some puffer fish contain the toxins tetrodotoxin and/or saxitoxin.

According to Fairfax County Health Department authorities, the individual who developed tetrodotoxin poisoning received the puffer fish in a package from relatives in South Korea, rather than purchasing it from a restaurant or other retail outlet in the United States.

What are the Symptoms of Puffer Fish Poisoning?

Symptoms resulting from ingesting tetrodotoxin and/or saxitoxin include tingling of the lips and mouth, followed by dizziness, tingling in the extremities, problems with speaking, balance, muscle weakness and paralysis, vomiting, and diarrhea. These symptoms can begin anywhere from 20 minutes to 2 hours after eating the toxic fish. In extreme cases death can result from respiratory paralysis.

What Do Consumers Need To Do? 

Consumers should only eat puffer fish (also known as fugu, bok, blowfish, globefish, swellfish, balloonfish, or sea squab) from two known safe sources.

The safe sources are:

  1. Imported puffer fish that have been processed and prepared by specially trained and certified fish cutters in the city of Shimonoseki, Japan, and
  2. Puffer fish caught in the mid-Atlantic coastal waters of the United States, typically between Virginia and New York. Puffer fish from all other sources potentially contain deadly toxins and therefore are not considered safe.

The Japanese government licenses specially trained fish cutters to process and prepare puffer fish. These fish are imported into the United States two to three times per year for special occasions, by only one approved New York importer, Wako International, under an FDA/Japanese government agreement. This is the only source of imported puffer fish that is covered by such an agreement. They are sold only to restaurants and dishes containing the fish are often very expensive, sometimes costing hundreds of dollars for a full meal. Any puffer fish not imported pursuant to the agreement between the United States and Japan is subject to FDA’s Import Alert 16-20, which informs FDA field staff that they may detain the fish without physical examination.

Puffer fish caught from the mid-Atlantic coastal waters of the United States do not contain these deadly toxins and are considered safe to eat. They are less expensive than imported puffer fish and may be found in markets or restaurants. However, puffer fish caught off the east coast of Florida should not be eaten because the entire fish is potentially toxic.

Before ordering or buying puffer fish, consumers should ask where it came from to ensure it is from a known safe source. Consumers who are unsure of the source should not eat puffer fish.

Who Should be Contacted? 

The FDA encourages consumers with questions about food safety to call 1-888-SAFEFOOD Monday through Friday between 10 a.m. and 4 p.m. Eastern time, or to consult the website:

The information in this release reflects the FDA’s best efforts to communicate what it has learned from state and local public health agencies involved in the investigation. The agency will update this page as more information becomes available.

For more information: 

FDA:  Consumer Advice on Puffer Fish

FDA:  Industry Advice on Puffer Fish

Page Last Updated: 11/03/2016
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