Three patients from Washington County, Georgia, went to a local hospital on September 8 with cranial nerve palsies and progressive, descending, flaccid paralysis resulting in respiratory failure. The patients had shared meals on September 7. When the doctors suspected botulism, botulinum antitoxin was administered. The patients had no further progression of their neurologic symptoms, but the patients remained hospitalized and on ventilators. Specimens from the patients and from leftover Bolthouse Farms Carrot Juice subsequently yielded botulinum toxin, type A. On September 16, a patient in Tampa, Florida, was hospitalized with respiratory failure and descending paralysis. Specimens from the patient and leftover Bolthouse Farm carrot juice again yielded botulinum toxin, type A. The product had been sold in all US states, Mexico, Canada, and Hong Kong. Two additional cases were confirmed in Toronto, Canada.