Three cases of tetrodotoxin occurred among chefs in San Diego, California, who shared contaminated fugu (puffer fish) brought from Japan by a co-worker as a prepackaged, ready-to-eat product. Symptoms of illness began within twenty minutes of ingestion. The ill were transported to a hospital emergency room and treated. The remaining fugu was obtained for toxin analysis at the FDA (results not available in article). Japanese health authorities were notified of the product. Tetrodotoxin is heat-stable and affects the nerves that control the skeletal muscles. Diagnosis of tetrodotoxin poisoning is based solely on clinical symptoms and a history of eating fish that are known to contain this toxin. Sixty percent of persons who ingest tetrodotoxin are likely to die. Fugu is a delicacy in Japan. Chefs generally have special training in preparation of the fish. Despite this training, approximately 50 deaths due to tetradotoxin occur each year in Japan.