The U.S. Food and Drug Administration is working with local officials to investigate a case of tetrodotoxin poisoning in Fairfax County, VA, which they suspect is linked to the consumption of imported puffer fish, according to a report from FDA. The patient under investigation received the puffer fish in a package from relatives in South Korea and did not purchase it from a restaurant or grocery store. If not prepared and processed by specially trained and certified fish cutters – as required by law – puffer fish has the potential to seriously sicken consumers. The poison can be found in the liver, intestines, skin and reproductive organs of some puffer fish. Symptoms of tetrodotoxin poisoning include tingling of the lips and mouth, followed by dizziness, tingling in the arms and legs, difficulty speaking and balancing, muscle weakness, paralysis, vomiting and diarrhea. Symptoms can appear anywhere from 20 minutes to two hours after consuming the toxin. Death from respiratory paralysis can occur in extreme cases. FDA recommends consumers only eat imported puffer fish that have been specially prepared by certified fish cutters in the city of Shimonoseki, Japan. Domestic puffer fish caught between the mid-Atlantic coast of Virginia and New York do not contain toxins and are also considered safe to eat, while all other sources are potentially hazardous.