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In February 2009, a Malaysian fisherman died and four others were hospitalized after they consumed a meal of pufferfish when they ran out of food while at sea. In March 2008, a fisherman in the Philippines died and members of his family became ill from pufferfish. Of the 23 incidents reported in Tokyo from 1993 through 2006, only one took place in a restaurant; all others involved people catching and eating the fish. Toxicologists have been working for years on developing an antidote for tetrodotoxin. The practical test allows chefs fifty-six minutes to remove the poisonous parts of fugu and prepare raw fish, bulgogi, and soup. The written portion covers the Fugu’s poison, hygiene, basic food safety, and conceptionsclarification needed of Korean cuisine.
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The list names safe genera including pufferfish of the Lagocephalus and Sphoeroides genera and the related porcupinefish (Harisenbon) of the family Diodontidae. The Ministry of Health, Labour and Welfare of Japan provides a list that shows which species’ body parts can be consumed. Other species are also eaten; for example, Higanfugu (T. pardalis), Shōsaifugu (T. vermicularis syn. snyderi), and Mafugu (T. porphyreus). Despite its toxicity, TTX has clinical therapeutic applications, being evaluated in phase II and III clinical trials to be effective for treating cancer-related pain without increasing serious adverse events.

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Bandō claimed to be able to resist the poison, but died several hours after returning to his hotel. According to the Fugu Research Institute, 50% of the victims were poisoned by eating the liver, 43% from eating the ovaries, and 7% from eating the skin. Much higher figures were reported in earlier years, peaking in 1958 when 176 people died from eating fugu in a single year. There is no known antidote, and treatment consists of emptying the stomach, administering activated charcoal to bind the toxin, and putting the person on life support until the poison has worn off. The symptoms of tetrodotoxin poisoning include dizziness, exhaustion, headache, nausea, and difficulty of breathing.
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Pufferfish native to American waters, particularly the genus Spheroides, have also been consumed as a seafood delicacy, sometimes resulting in poisoning incidents. Pufferfish native to American waters, particularly the genus Sphoeroides, have also been consumed as a seafood delicacy, sometimes resulting in poisoning incidents. In January 2024, a Brazilian man, 46, died after eating pufferfish given to him by a friend. In December 2020, 3 people in the Philippines died, while 4 more were hospitalized after eating pufferfish.
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