Table 6.

Victims of A-series agent poisoning

Year of incident	Victim (age)	Route of exposure	Onset	Acute symptoms	Hospitalization	Therapy	Outcome	Possible delayed symptoms
1987a (Tucker 2006; Mirzayanov 2008; Dobrynin 2018; Roth and McCarthy 2018)	Man (n/a)	Inhalation	Immediately	Mydriasis, bronchorrhea, vomiting, hallucinations, unconscious	Over 1 week	Vodka, tea, atropine	Survived	Inability to walk, read, and concentrate, chronic arm weakness, trigeminal neuritis, hepatitis with subsequent cirrhosis, epilepsy, depression
1995b (110–114) (Stanley 1995; Kislinskaya 2001; Felshtinsky and Pribylovsky 2010; Shleinov 2018a, b)	Man (46)	Transdermal, inhalation exposure was also possible	Hours: the police report states that the latent phase for skin exposure could last 1.5–5 h	Complete picture NA (coma, multiorgan failure)	3 days	n/a, possibly symptomatic, except for small doses of atropine for examination of the eye fundus	Dead	n/d
	Woman (35)			Full picture NA (convulsions, circulatory disorder, coma, multiorgan failure)	1 day	n/a, possibly symptomatic	Dead	n/d
				Other victims complained about headaches, dizziness, lacrimation	n/a	n/a	n/d	n/d
2015c (115–118) (Bellingcat Investigation Team 2019a, b; Dimitrov 2019; The Insider and Bellingcat 2020)	Man (65)	Transdermal, inhalation exposure was also possible	Hours	Nausea, vomiting, eye itching, vision disorders, coma	17 days	n/a	Survived	n/a
	Man (n/a)		Hours	Vomiting, slurred speech, blurred vision, miosis, excessive sweating, hypertension, coma	9 days	n/a	Survived	n/a
	Man (n/a)		Four days	Full picture NA (milder than the two previous victims, coma)	n/a	n/a	Survived	n/a
2018d (Stone 2018; BBC News 2018a, b; Technical Secretariat 2018; PHE 2018; Technical secretariat 2018; Counter Terrorism Policing 2018; Vale et al. 2018; Morris et al. 2019; Ridley 2019; Morris 2021)	Man (66)	Transdermal	Hours	Briefing note released by PHE summarized symptoms: painful dim vision, miosis, involuntary defecation, impaired breathing, sinus bradycardia, fasciculations, muscle weakness, hypotension, convulsions, coma	72 days	Atropine, pralidoxime, ventilation, neuroprotection, and probably also naloxone to exclude opioid overdose	Survived	n/a
	Woman (33)				37 days		Survived	n/a
	Man (41)				16 days		Survived	n/a
	Man (45)				18 days		Survived	n/a
	Woman (44)	Transdermal, inhalation exposure was also possible	Minutes		8 days		Dead	n/d
2020e (Science’s news staff 2020; Smolentseva 2020; Stone 2020; Technical Secretariat 2020; Steindl et al. 2021)	Man (44)	Transdermal	Hours	Nausea, vomiting, hypersalivation, sweating, miosis, conjunctival injection, bradycardia, collapse, muscle stiffness, convulsions, hypothermia, confusion, unconsciousness, the elevation of plasma lipase and amylase	31 days	Atropine, obidoxime, midazolam, fentanyl, tropicamide, morphine, propofol, crystalloids, ventilation	Survived	n/a

PHE public health England, n/a not applicable, n/d no data

^aThe first known victim of poisoning with “Novichok,” specifically A-232, was scientist Andrei Zheleznyakov in 1987 after the ventilation in his laboratory failed (Mirzayanov 2008; Roth and McCarthy 2018)

^bRussian banker Ivan Kivanli and his secretary were intoxicated with a military-grade nerve agent (Stanley 1995). The exposure (A-234, according to the chromatograph in the police report) most likely occurred through contact with the telephone receiver. The police file mentions that signs of intoxication were also present in his bodyguard, visitors, a cleaning lady, and 8 police officers (Shleinov 2018a, b)

^cBulgarian arms dealer Emilian Gebrew and a close business partner were exposed to unknown OP through contact with car door handles. Gebrev’s son was also intoxicated. Newspapers state that two other men fell ill, but symptoms were not mentioned. The Finnish laboratory VERIFIN found traces of two organophosphorus compounds in a blood sample (Bellingcat Investigation Team 2019a). Following the publication of the poisoning of Sergei Skripal, the same compound (A-234) was suspected (Bellingcat Investigation Team 2019b). The loss of the tested samples made it impossible to identify the exact composition of the agent (Morris et al. 2019)

^dA former GRU agent, Sergei Skripal, and his daughter were intoxicated with A-234 (Security Council 2018). Four months after their poisoning, two other citizens were exposed to the same substance found in a vial (Ridley 2019). The UK government’s Defence Science and Technology Laboratory (DSTL) at Porton Down confirmed the same identity of the substance (Technical secretariat 2018). Another 22 people were investigated for intoxication, with 1 showing mild symptoms

^ePoisoning of Alexei Navalny. The detected biomarkers in the samples indicated a toxic substance structurally, like A-series nerve agents (Technical Secretariat 2020). This phosphate compound carried a guanidine moiety, mimicking A-242. The substance used for poisoning was possibly A-262 or another closely related phosphate substance bearing the same branch (Technical Secretariat 2020)