Investigators believe botulism toxin from bottled carrot juice paralyzed a woman in Florida, making her the fourth person in the United States thought to be poisoned by bacteria in the drink.

The unidentified woman is unresponsive and has been hospitalized in Tampa since mid-September, Jylmarie Kintz, the epidemiologist for the Hillsborough County Health Department, said on Friday.

Three people in Georgia also became ill after drinking the bottled juice made by Bolthouse Farms, according to the U.S. Food and Drug Administration. Their conditions have not been released.

The FDA said the victims may have improperly handled the juice after purchase. Fresh carrot juice is low in acid, which means it must be kept refrigerated to prevent the growth of bacteria.

The FDA is investigating other possible causes and has issued a warning to consumers not to drink Bolthouse Carrot Juice with a use-by date of Nov. 11 or earlier.

Bolthouse Farms of Bakersfield, Calif., issued a voluntary recall for the juice last week.

The Canadian Food Inspection Agency issued a recall of the carrot juice on Sept. 30. The recalled bottles, sold in one litre and 450-millilitre sizes, may have been distributed across Canada.

Botulism poisoning symptoms include double vision, droopy eyelids, trouble speaking or swallowing and paralysis on both sides of the body that progresses from the neck down.