Type E botulism occurred in three patients, one of whom died. The most prominent feature in all three cases was severe gastrointestinal symptoms (vomiting and abdominal discomfort without diarrhea), which diverted attention from the less prominent and more slowly developing neurological signs. Type E botulinus toxin was detected in the blood of the patient who died. The botulinus toxin was traced to home-prepared gefilte fish from which the three patients had eaten at a common meal. Lethal quantities of type E botulinus toxin were found in extracts of leftover gefilte fish, andClostridium botulinumtype E was recovered from cultures of the food. The incriminated food, which was eaten cold, had been prepared from fresh Great Lakes whitefish, cooked, and stored in a sealed jar in a household refrigerator for seven weeks before it was opened on the day of the meal.