Update: EVALI Case Count Grows in CDC’s Weekly Vaping Illness Report

UPDATE: November 4, 2019 – 12:07 p.m. PDT – Numbers for the vaping-related outbreak that has affected patients in every state except Alaska, have risen to 1,888 cases attributed to EVALI (E-cigarettes or Vaping product use Associated Lung Injury), as well as thirty-seven deaths in twenty-four states.

The CDC, who continues with a multi-agency investigation into the specific cause for the mysterious lung condition, updated the information on Thursday.


One death, according to media reports, that has not yet been added to the CDC’s weekly update occurred on September 6, in Georgia. As reported by news network CNN, the victim was a 52-year old woman that had a history of smoking nicotine vape products, in order to quit cigarettes.

After a trip to California, where cannabis is recreationally legal and where the woman tried THC vape products for the first time, she returned to Georgia, where cannabis is illegal. According to her family, she continued to use THC vape products purchased on the illicit market, which may have led to her death.

She had been diagnosed with pneumonia when her condition worsened quickly, but was not diagnosed with EVALI at the time of death, according to reports. Results from the county medical examiner were pending, to determine cause of death.

The woman’s family put partial blame for the incident on the Food and Drug Administration, for lack of nationwide safety standards and regulation on vaping products.

UPDATE: October 28, 2019 – 4:58 p.m. PST – The Michigan Department of Health and Human Services (MDHHS) on Friday announced findings from studies of patients affected by EVALI, the vaping-related condition that causes lung damage, and in thirty-four cases, death. In Michigan, there have been forty-four diagnosed cases and one death.

Officials from the FDA analyzed vape products that five patients had personally used and then turned over after being diagnosed with EVALI. An ongoing investigation involves federal and state officials.

Michigan’s test results are the first confirmation that one of the five patients was exposed to vitamin E acetate, also called Tocopheryl acetate. Early speculation to a possible cause for EVALI focused on vitamin E acetate, a material common in supplements and topical applications. Experts speculated chemical changes in vitamin E acetate, when exposed to high temperature during the vaping process, might be causing lung damage.

Other findings from the Michigan report included:

  • Two patients’ products contained only nicotine.
  • One patient’s products contained only tetrahydrocannabinol (THC).
  • One patient’s products contained both THC and nicotine.
  • One patient’s products contained THC and vitamin E acetate. One product, a Dank Vape Birthday Cake THC cartridge, contained twenty-three percent vitamin E acetate.

The MDHHS release also said, “In addition, two vaping cartridges submitted by a medical marijuana caregiver to a Michigan Marijuana Regulatory Agency licensed safety compliance facility also contained forty percent or more of vitamin E acetate.”

Data collected from the forty-four diagnosed cases in Michigan indicated that eighty-one percent of patients had used THC vape products.

Recommendations from Michigan officials based on the findings advised the public to avoid use of e-cigarettes and vape products, “particularly those that contain THC.”

UPDATE: October 25, 2019 – 2:15 p.m. PST – The CDC released its weekly information update on EVALI, the vaping-related condition still under investigation by federal and state officials.

As of October 22, more than 1,600 cases had been diagnosed, and the number of deaths attributed to EVALI reached thirty-four, in twenty-four U.S. states.

Officials from the Illinois Department of Public Health yesterday announced the second death from EVALI in the state. The first death attributed to lung damage from vaping occurred in Illinois, in August.

UPDATE: October 17, 2019 – 4:12 p.m. PST – The CDC has updated information connected to the ongoing vaping-related condition that was named EVALI last week by officials.

So far, the number has risen to thirty-three deaths in twenty-four states, with 1,479 cases attributed to lung damage from vaping. Federal, state, and local officials continue their investigation.

In Oregon today, the state Court of Appeals put a stay on the six-month ban on vape products called for by Governor Kate Brown after Oregon’s first fatal vaping case in September. The court’s decision affects only flavored nicotine products, so cannabis vape products will still be prohibited.

Today in New York, Governor Andrew Cuomo hosted the Governors’ Regional Cannabis & Vaping Summit, which was attended by other Democratic governors of neighboring states, including New Jersey Governor Phil Murphy, Pennsylvania Governor Tom Wolf, and Connecticut Governor Ned Lamont.

New York has imposed a 120-day ban on vape products, while public health officials work to find what is causing the mysterious condition. Other areas that have vaping bans in effect include the city of San Francisco, as well as Michigan, Rhode Island, Washington, Oregon, and Montana.

UPDATE: October 15, 2019 – 2:43 p.m. PST – The CDC on Friday updated information for the public and for health care providers related to the vaping crisis, including a name for the mysterious condition: EVALI, which is short for “e-cigarette or vaping product use-associated lung injury.”

The CDC also stated that the investigation is ongoing, while no substance, device, or process had been pinpointed as a cause for EVALI.

“Most patients report a history of using tetrahydrocannabinol (THC)-containing products. The latest national and state findings suggest products containing THC, particularly those obtained off the street or from other informal sources (e.g. friends, family members, illicit dealers), are linked to most of the cases and play a major role in the outbreak,” the update read.

On Wednesday, Utah state health officials reported the state’s first vaping-related death, which has caused controversy for state medical cannabis advocates who fear restrictions on developing regulation for Utah’s new medical cannabis markets. Currently, legislation allows vaping but not dried flower for smoking.

Libertarian think tank organization Libertas Institute President Connor Boyack spoke to local Deseret News and said, “It’s almost as if they’re using THC as some sort of scapegoat pending finding out what actually happened.”

Senate Majority Leader Evan Vickers (R-Cedar City) told the newspaper, “I know that the patients coalition and some others have indicated that vaping is an effective way to administer the medication. But then we’ve also got this challenge, of the troubling aspect of what’s going on with vaping across the country right now.”

Republican Utah Senator and former presidential candidate Mitt Romney on Thursday hosted a roundtable on vaping, after officials had confirmed the state’s first vaping fatality.

“Tragically, Utah had its first vaping-related death this week. Sitting down with health experts from @UtahDepOfHealth, @UofUHealth, @AmericanCancer, and more at @PrimaryChildren in Salt Lake City to discuss anti-vaping efforts in Utah and potential action at the federal level,” Romney said in a Tweet.

UPDATE: October 10, 2019 – 5:00 p.m. PST – In its weekly update about the nationwide vaping crisis, the Centers for Disease Control (CDC) today said twenty-six deaths of individuals ranging from 17 years to 75 years of age have now been confirmed across twenty-one states. Additional fatalities remain under investigation.

The deaths occurred in Alabama, California (3), Connecticut, Delaware, Florida, Georgia (2), Illinois, Indiana, Kansas (2), Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, Oregon (2), Pennsylvania, Texas, and Virginia.

The agency also released demographic information for 1,043 of the now 1,299 reported cases of vaping-related lung injury, of those:

  • 70 percent are male.
  • The median age is 24 years and ranges from 13 years to 75 years.
  • By age group category:
    • 15 percent are under 18 years old;
    • 21 percent are 18 to 20 years old;
    • 18 percent are 21 to 24 years old;
    • 26 percent are 25 to 34 years old; and
    • 20 percent are 35 years or older.

In the statement, CDC assured the public that it is working around the clock to “identify the cause or causes of this outbreak.” However, “the specific chemical exposure(s) causing lung injuries associated with e-cigarette use, or vaping, remains unknown at this time.”

UPDATE: October 9, 2019 – 3:30 p.m. PST – The U.S. Army today became the first branch of the United States military to report cases of vaping-related pulmonary illness among its soldiers. Two cases were identified: One soldier was treated and released from a medical facility in the U.S., and a second soldier stationed overseas is still receiving care.

The news follows a ban enacted October 1 discontinuing sales of e-cigarettes and vaping products at all Army, Navy, and Air Force base exchanges.

In an earlier statement, the Army Public Health Center advised military personnel and their families “to avoid all e-cigarette and vaping products, particularly those sold off the street or modified to add any substances not intended by the manufacturer.”

In related news, pharmacy retail chain Walgreens on Monday announced its intention to “stop selling e-cigarette products at [its] stores nationwide.”

UPDATE: October 8, 2019 – 4:00 p.m. PST – The death toll from lung damage related to vaping continues to rise, with two fatalities announced within the last twenty-four hours.

Massachusetts saw its first vaping-related casualty; and a death in the Bronx, New York, is reported to be the first case of a teenager succumbing to the condition. The patient was a seventeen-year old male that had been hospitalized last month.

These latest deaths bring the total to twenty-one fatalities so far.

Bans on flavored vaping products, some THC and tobacco vape products, as well as e-cigarettes are widening as public health officials and large retailers move to restrict sales, at least while the investigation—by the Centers for Disease Control and FDA, working with local and state officials—is currently underway.

A second vaping-related death in Oregon last month prompted Governor Kate Brown on Friday to put a six-month ban on flavored vapes and additives.

Montana Governor Steve Bullock today announced a statewide four-month ban on flavored vape products, which will begin being implemented on October 22.

“Protecting the health, safety, and well-being of all Montanans—especially our kids—is one of my top priorities as governor, and I join the other parents across this state knowing we cannot rest until we do everything we can to keep our kids safe,” Bullock said in a press release. “This is the right thing to do during the outbreak of these illnesses and deaths and it’s the right thing to do for the future leaders of our state.”

On the retail side; national grocery store chain Kroger on Monday announced that they would cease sales of e-cigarettes, citing regulatory uncertainty around nicotine vape products, like popular JUUL pods and other e-cigarettes. The grocer follows mega-retailer Walmart, which banned sales of e-cigarettes and vape products in mid-September.

UPDATE: October 5, 2019 – 12:49 p.m. PST – The Food and Drug Administration (FDA) yesterday released an advisory update on the vaping-related respiratory condition that has affected more than 1,000 users in the United States.

The advisory specifically warned individuals not to use THC-containing vape products, as well as any vape products obtained “off the street,” illicit, or social sources.

The update also recommended that teens and pregnant women specifically avoid vaping. Any individuals who choose to vape should monitor themselves for symptoms, including “cough, shortness of breath, [and] chest pain.” Healthcare providers should also identify symptoms in patients with a history of vaping.

The statement read in part: “The FDA’s Forensic Chemistry Center is using state-of-the-art technology to analyze hundreds of samples submitted by a number of states for the presence of a broad range of chemicals, including nicotine, THC, other cannabinoids, and opioids along with cutting agents/diluents and other additives, pesticides, poisons, heavy metals and toxins.

“No one substance has been identified in all of the samples tested. Importantly, identifying any compounds that are present in the samples will be one piece of the puzzle but will not necessarily answer questions about what is causing these illnesses.”

UPDATE: October 4, 2019 – 3:19 p.m. PST – The vaping crisis continues to expand with the number of deaths attributed to the mysterious respiratory condition now at eighteen in fifteen states, and 1,080 diagnosed cases in forty-eight states.

An update from the Centers for Disease Control said, “Most patients report a history of using THC-containing products. The latest national and regional findings suggest products containing THC play a role in the outbreak.”

The statement also said that seventy percent of the patients are male, and eighty percent are under 35-years old. Updated CDC information on fatalities linked to vaping said deaths have occurred in “Alabama, California (2), Delaware, Florida, Georgia, Illinois, Indiana, Kansas (2), Minnesota, Mississippi, Missouri, Nebraska, New Jersey, Oregon (2), and Virginia.”

The CDC did, again, emphasize that because the situation is occurring in a dynamic environment, there is no one substance or device that has been determined to be the likely cause of lung injury. As its investigation, which includes officials from the FDA and DEA, is ongoing, officials warned against the use of any vape products.

“Users may not know what is in their e-cigarette or e-liquid solutions,” the CDC statement said, “Many of the products and substances can be modified by suppliers or users. They can be obtained from stores, online retailers, from informal sources (e.g. friends, family members), or ‘off the street.’”

The Mayo Clinic, on Tuesday, released findings of a small study of biopsies from seventeen patients with a history of vape use. Contrary to earlier speculation that the lung condition might be attributed to a single ingredient, like Vitamin E acetate, the findings suggest “lung injuries from vaping most likely are caused by direct toxicity or tissue damage from noxious chemical fumes.”

“The study was the first to examine a group of biopsies from patients with lung injury due to vaping,” said a post on the Mayo Clinic news network blog.

“Researchers found no evidence of tissue injury caused by accumulation of lipids—fatty substances such as mineral oils—which has been suspected as a possible cause of the lung injuries associated with vaping,” it said.

“This is a public health crisis, and a lot of people are working frantically around the clock to find out what the culprit or culprits could be—and what chemicals may be responsible,” Dr. Larsen, senior author of the study said. “Based on what we have seen in our study, we suspect that most cases involve chemical contaminants, toxic byproducts, or other noxious agents within vape liquids.”

UPDATE: October 1, 2019 – 4:30 p.m. PST – In news reports today three more deaths have been attributed to the vaping-related respiratory condition that has affected more than 800 people in forty-six U.S. states and the U.S. Virgin Islands.

The Centers for Disease Control (CDC) updated the official number of deaths to twelve last week, these most recent deaths would bring the total to fifteen. A sixteenth death is disputed since the CDC did not report it last week, though officials said there may be updated information forthcoming. The death that was not accounted for in the CDC update was a second fatality in Oregon, as reported by local news media.

According to the CDC update, previous deaths include twelve deaths in ten states: two each in California and Kansas, and single cases in Georgia, Florida, Illinois, Indiana, Minnesota, Missouri, Mississippi, and Oregon.

The fatalities today include the first reported vaping-related deaths in Nebraska, New Jersey, and Virginia, bringing the number of states with reported fatalities to thirteen.

WASHINGTON, D.C. – The Centers for Disease Control (CDC) on Friday gave a telephone press conference to update the latest information on the vaping-related respiratory condition that has spread across the U.S. since late August, resulting in fatalities and hundreds of affected patients.

“As of September 24, 805 confirmed and probable cases of lung injury associated with e-cigarette use or vaping were reported to us by forty-six states and the U.S. Virgin Islands. Sadly, twelve deaths have been confirmed in ten states. More than two-thirds of patients are male, and the median age of cases is 23 years. About 62 percent of patients were age 18-to-34 years, and 54 percent were under 25 years of age,” said Dr. Anne Schuchat, principal deputy director at the CDC.

“These reports suggest that THC-containing products play a role in the recent cases.” Dr. Schuchat added.

“On the national level out of 514 patients with exposure histories, we found 77 percent reported using THC-containing products or using both THC-containing products and nicotine-containing products. Information about substance use was self-reported by the 514 patients. Of the patients that reported what products they used, THC-containing products were the most prominent link across patients… Only 16 percent reporting using only nicotine-containing products,” she said.

The twelve fatalities accounted for by the CDC is one less than had been reported earlier by media; Dr. Schuchat later mentioned that it was likely there would be more deaths from the mysterious condition and that the CDC received data weekly from states reporting deaths.

Analysis results were contained in the first report issued, on Thursday, by the CDC from its ongoing investigation into the vaping-related fatalities and more than 800 patients that suffered lung damage attributed to the unknown condition. The report was published in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

Though officials emphasized there was not yet any conclusive findings about the specific cause of the vaping illness epidemic, they advised the public to discontinue use of all vape products, especially e-cigarettes and THC-infused products.

The CDC also stated that because of the large number of patients, scattered across forty-six states and the U.S. Virgin Islands, and the vast number of products used by these individuals, the process of pinpointing a cause has been complicated and will require more investigation before a specific cause can be determined.

The Food and Drug Administration (FDA) has launched a criminal investigation, and is working alongside the CDC, as well as with local and state health officials. The Drug Enforcement Administration (DEA) is also aiding in the investigation.

Illinois-based infectious disease specialist Dr. Jennifer Layden described the difficulty of analysis for this first CDC report, which focused mainly on data gleaned from patients in Illinois and Wisconsin:

“Among all eighty-six patients in our study, 234 unique e-cigarette or vaping products across eighty-seven different brands were reported. While no one brand was reported by all patients, pre-filled THC cartridges labeled under the brand name Dank Vapes was most common, with 66 percent of all patients reporting this name. Second, despite not having consistency in product or brand names, the vast majority of products used were prepackaged, pre-filled cartridges. Of all the THC base products that were used and reported to us, 96 percent were prepackaged, pre-filled cartridges.”

“Finally, THC products were most often acquired from informal sources such as on the street, from friends, or from a dealer,” Dr. Layden added.

“These findings do highlight predominant use of prepackaged, pre-filled THC cartridges obtained through informal sources. At this time, however, we can unfortunately not identify one product, brand, source, or device that’s common across all patients,” Dr. Schuchat said when questioned by media.

“We do not know even for the THC containing products that seem to be closely linked with cases in Illinois and Wisconsin—what the substance is within the products that’s causing harm,” Dr. Schuchat said further.

“We have many questions about the supply chain and the integrity of these products. So, I think that we need to have an open mind and [learn] a lot more about the supply chain, as well as about the contents of various products that are used within e-cigarettes or vaping to understand which of many toxins might be leading to this type of lung injury,” she said.

In a related story, Washington state joins several others in issuing a ban on flavored vape products. Democratic Governor Jay Inslee on Friday issued an executive order asking the Washington State Board of Health to give an emergency order at its next meeting on October 9. The order would ban the sale of all flavored nicotine and THC-infused vaping and e-cigarette products for at least four months.

Massachusetts has also instated a four-month ban on all vaping products, while Michigan, New York, and Rhode Island have issued temporary bans. Oregon and California have not moved to impose statewide bans, but have warned the public not to use vape products. Last week, the Los Angeles County Board of Supervisors banned flavored tobacco and cannabis-based products, including menthol cigarettes. At the federal level, the Trump administration said recently that it would move to “ban the sale of most flavored e-cigarettes.”

Ed. Note: This is a developing news story, more information will be added as it becomes available. See mg‘s previous coverage for earlier details about the epidemic.

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