Sixth Sudafed Pack With Signs of Tampering Found : Poisoning: Foil is cut and one capsule is different. Cyanide in the drug has killed two people and injured a third in the Tacoma, Wash., area.

Food and Drug Administration inspectors in Washington state found a sixth suspicious pack of Sudafed on Tuesday in the Tacoma area, where cyanide-laced capsules already have killed two people and seriously injured a third.

The foil on the blister pack--a tamper-resistant feature inside the carton--had been “cut and pulled back and then pushed back into place,” said Jeff Nesbit, an FDA spokesman in Washington, D.C.

One capsule found in a corner inside the blister pack also appeared to have been tampered with, Nesbit said. “This capsule was visibly different from the other capsules,” he said.

The FBI will analyze the capsule to determine if it contains cyanide, Nesbit said. His agency is still awaiting results on tests of two other suspicious capsules.

Unlike the other blister packs linked to the tampering, which contained 10 capsules, the latest was a 20-capsule pack, Nesbit said. Like the others, the lot number on the pack did not match the number on the outside carton, although it differed from the lot number found on the previous blister packs.

The latest package was found by FDA inspectors, who thus far have examined 20,000 boxes of Sudafed 12-hour capsules taken from stores in the Tacoma-Olympia area.

The six packages associated with tampering have been traced to six different stores near major intersections of a 25- to 30-mile stretch of Interstate 5, between Tacoma on the north and Olympia on the south.

“Someone obviously just drove up and down Interstate 5 and dropped these off in stores,” Nesbit said.

As a result of previous tamperings, including a 1982 episode in which seven people in the Chicago area were killed by cyanide-tainted Tylenol, the non-prescription drug industry initiated a series of measures to discourage tampering. These included such features as internal blister packs, outer seals and colored bands around capsules.

“Industry has pretty much done what it knows how to do,” said John T. Walden, a spokesman for the Nonprescription Drug Manufacturers Assn. “In this case, there were three separate devices on this product--and people still got hurt.

“What it comes down to is this. Look at the package on the shelf. If there’s any damage to the packaging, don’t buy it. If it looks wrong or smells wrong or tastes wrong--don’t swallow it.”

The FDA’s Nesbit agreed. “Consumers should look twice,” he said. “In this case, they could have noticed one of three different things. The outer tab was cut and reglued. The foil on the back was cut and pushed back into place, and the capsule looked different.”

Walden said the foil backing on the blister pack “looked like it had been slit with a razor, the capsule itself was oversized and the purple band that sealed the capsule was missing.”

Evidence of cyanide poisoning was found in the body fluids of three people in the Tacoma-Olympia area who had taken Sudafed. One of the individuals, a woman, survived after her stomach was pumped.

Doctors removed the organs of one of the victims, Stan McWhorter, and transplanted them into five different patients before realizing that McWhorter’s death was apparently caused by cyanide poisoning. But they said there is little likelihood that the organs contained enough poison to harm the transplant recipients.

Burroughs Wellcome Co., the manufacturer of the capsules, announced a nationwide recall Sunday. All of the known poisoning incidents were confined to the Tacoma-Olympia area.