Symptoms can occur anywhere from 12 to 36 hours to eight days after eating toxin-contaminated food. The early symptoms of botulism are mild. Dizziness, fatigue, and weakness are common complaints. None of the early symptoms indicate the seriousness of the disease. Later, neurological symptoms develop, including difficulty in speaking and swallowing, and double vision. Fever rarely is present. Abdominal distension can further complicate the diagnosis leading to the incorrect conclusion of appendicitis. As more toxin binds to more nerve cells, paralysis sets in. Weakness of the muscle groups in the neck, extremities, and respiratory muscles is followed by complete paralysis.