<p>We identified 48 cases (47 male); 18 (38%) died. The median age of cases was 32 years (IQR 26-46). Compared with case-patients who consumed ≤1 200ml bottle of Gin X, the risk of dying was 10 times higher (RR=10.7, 95% CI: 1.5-75, p=0.02) among those who drank ≥3 bottles. The mean methanol content among five Gin X samples collected from manufacturer A was 594,424 mg/L (range 259,263-809,193 mg/L). Autopsies of eight case-patients all showed liver inflammation oedema, gastrointestinal bleeding, and pulmonary oedema, consistent with methanol poisoning. A disagreement between the chemist and owner at Manufacturer A had led to the abrupt recent departure of the chemist, four days before the first case-patient’s onset on 17 August 2022. In July 2022, Manufacturer A had been denied a license to produce gins.</p>