On May 21, 2023, about 1447 eastern daylight time, a Cessna R182, N182LG, was destroyed when it was involved in an accident near Macon, North Carolina. The private pilot was fatally injured. The airplane was operated as a Title 14 Code of Federal Regulations Part 91 personal flight. The airplane was departing from runway 18 at Nocarva Airport (NC10), Macon, North Carolina. Runway 18 was 1,900 ft-long, 100 ft-wide, and consisted of a turf surface. According to a witness (who was also a pilot) and video recorded by a witness, the airplane travelled along the runway in a nose-high attitude with the tail dragging in the turf. The airplane lifted off nose high, the wings buffeted, and the airplane drifted left into trees. The engine was operating continuously, and no abnormal engine sounds were heard by the witness or during the portion of the takeoff that was video recorded. A postimpact fire consumed a majority of the wreckage, which came to rest in a wooded area off the left side of the runway, about three-fourths down the runway. The wreckage was subsequently recovered from the accident site and examined. Elevator control cable continuity was confirmed from the cockpit, through recovery cuts, to the elevator bell cranks. Rudder cable continuity was confirmed from the cockpit pedals to recovery cuts at the rear empennage. The aileron cable remained attached to the left and right aileron bellcranks and in the cockpit; however, the aileron cable from the cockpit to the wing was not identified. Measurement of the flap jackscrew corresponded to a flaps near retracted position (between 0° and 2° extension). Measurement of the elevator trim actuator corresponded to a full tab down (nose-up) elevator trim position. The pilot’s seat tracks were not identified. The engine remained attached to the airframe and was separated and lifted with a hoist for examination. The three-blade propeller remained attached to the crankshaft flange. One blade exhibited s-bending, one blade was bent forward, and the third blade was bent aft. All three blades exhibited chordwise scrapes. Borescope examination of the cylinders did not reveal any anomalies. The top spark plugs were removed, and their electrodes were intact and sooty. When the propeller was rotated by hand, crankshaft, camshaft, and valve train continuity was confirmed to the rear accessory section of the engine. Thumb compression was attained on all cylinders. Due to fire damage, the ignition system and fuel system could not be tested. Overall, the examination of the wreckage did not reveal evidence of any preimpact mechanical malfunctions. Review of a before takeoff checklist from a pilot operating handbook for the make and model airplane revealed instructions to set the elevator trim to the takeoff position before takeoff. An autopsy was performed on the pilot by the North Carolina Office of the Chief Medical Examiner, Raleigh, North Carolina. According to the pilot’s autopsy report, his cause of death was thermal injuries and inhalation of products of combustion, and his manner of death was accident. Toxicological testing of postmortem specimens from the pilot was performed by the FAA Forensic Sciences Laboratory, Oklahoma City, Oklahoma. Cetirizine (trade name Zyrtec) was detected at 32 ng/mL in heart blood and at 223 ng/mL in liver tissue. Naproxen (trade name Aleve) was detected in heart blood and liver tissue. Cetirizine is a second-generation antihistamine medication that is available over the counter and is commonly used to treat allergy symptoms. Cetirizine often carries a warning that users may experience drowsiness and the FAA states that pilots should wait 48 hours after using cetirizine before flying, to allow time for the drug to be cleared from circulation. Data on sedation and psychomotor impairment from cetirizine are mixed, with some studies finding some sedating and impairing effects. The investigation could not determine if the cetirizine had any impairing or sedating effects on the pilot at the time of the accident. Naproxen is an anti-inflammatory medication that is available without a prescription and commonly is used for control of pain and fever. Naproxen is not generally considered impairing. All other detected substances were attributable to the pilot’s postaccident medical care.