An investigation was conducted into the clinical symptoms and causative agent associated with a whelk poisoning incident that occurred in March 2005 in Korea. The whelk consumed in the poisoning incident was identified as Neptunea intersculpta. All of the 17 patients suffered from eyeball pain, headache, dizziness, abdominal pain, and nausea but no diarrhea. The causative agent was identified as tetramine, based on results from liquid chromatography-tandem mass spectrometry. Based on the tetramine concentration in the leftover whelk meat and the amount of meat consumed, the amount of tetramine ingested by the patients was estimated to be > or = 10 mg. This is the first report of the identification of tetramine as the causative agent in whelk poisoning in Korea. The anatomical distribution of tetramine in fresh and boiled N. intersculpta was examined. The toxin concentration in the meat was higher in specimens boiled in the shell than in fresh specimens collected on the same date. In meat boiled separately after removing the shell, the salivary gland, and the midgut gland, the tetramine concentration was much lower than that in fresh specimens or those boiled in the shell. This result suggests that boiling the meat after removing the salivary gland is a suitable way to prevent tetramine poisoning.