Update: Vaping Illness Death Toll Climbs; More Vape Product Bans Enacted

Ed. Note: See updated article for continuing coverage.

UPDATE: September 27, 2019 – 2:20 p.m. PST – A second death attributed to vaping has been reported in Oregon today, bring the nationwide total of fatalities to thirteen; two in California, two in Kansas, two in Oregon, and one each in Illinois, Indiana, Minnesota, Missouri, Florida, Georgia, and Mississippi.


Local news outlet Willamette Week reported on the latest death and comments from public health and government officials. Oregon Governor Kate Brown was reported to have requested the Oregon Health Authority to “look at options we have for potentially decreasing the impact of this illness,” said State Health Officer Dean Sidelinger.

“All of these individuals reported using cannabis products, all from licensed retailers,” he added.

NBC News also teamed with cannabis industry testing lab CannaSafe to take a closer look at both legal and “bootleg” THC vape cartridges. Test results, published today, were disturbing.

UPDATE: September 26, 2019 – 5:00p.m. PST – Health officials at the Centers for Disease Control updated the number of fatalities to twelve; two in California, two in Kansas, and one each in Florida, Georgia, Illinois, Indiana, Minnesota, Missouri, Mississippi, and Oregon.

Florida and Georgia reported the first vaping-related deaths in their states this week, while Mississippi health officials reported the state’s first death today, as the number of fatalities has spiked over two days, from nine to twelve deaths.

CDC officials also increased the number of cases attributed to the vaping syndrome from 530 reported last week, to 809 cases, which have spread to “almost every state.”

The House Energy and Commerce Committee subcommittee on vaping heard testimony from Food and Drug Administration officials yesterday regarding the vaping situation.

Acting Commissioner of Food and Drugs at the FDA Norman E. “Ned” Sharpless, M.D., yesterday released a press release statement that was prepared for the subcommittee and said, in part:

“That’s why the President announced his support for the FDA’s intention to soon finalize a compliance policy related to flavored ENDS [electronic nicotine delivery systems]. This policy would prioritize FDA’s enforcement of premarket authorization requirements for non-tobacco flavors. FDA is not ‘banning’ flavors, as has been described in some news reports. Rather, FDA intends to enforce existing law that limits the marketing of such products.

“This policy would not mean that flavored e-cigarettes could never be marketed. If a company can show through an application to FDA that a specific product meets the standard set forth by Congress, then the FDA would authorize that ENDS product for sale.

“FDA intends to prioritize enforcement action such that flavored e-cigarette products will be expected to exit the market unless and until manufacturers of these products provide scientific evidence demonstrating that marketing their products is appropriate for the protection of the public health,” the statement continued.

Los Angeles County officials announced the “Your Body First” anti-vaping initiative, which will target teens with bi-lingual ads that warn of the dangers of vaping. The initiative program has a $1.5 million budget.

This follows Los Angeles County Board of Supervisor’s decision yesterday to ban all flavored tobacco/nicotine products, including menthol cigarettes.

UPDATE: September 24, 2019 – 5:30p.m. PST – Kansas health officials today reported another death attributed to the vaping-related respiratory condition that has affected hundreds of vape users in thirty-eight U.S. states.

This latest death bring the number of fatalities to nine, including a previous death in Kansas, two in California, and one death each reported in Illinois, Indiana, Minnesota, and Oregon.

The Los Angeles County Board of Supervisors today made the unanimous decision to ban all flavored nicotine and tobacco products in unincorporated areas of the county, which would affect about one million Los Angeles county residents. The decision came after a long, packed public meeting about the topic.

“We have a responsibility to care for them and make sure the environment is safe,” said Supervisor Mark Ridley-Thomas, who introduced the measure, according to local news ABC7.com.

California health officials again warned the public to stop vaping, amid the Centers for Disease Control’s multi-state investigation of the condition.

The Governor of Massachusetts Charlie Baker (R) today also enacted an emergency four-month ban on all vaping products sold in the state. The ban, which was approved by the Massachusetts Public Health Council, will last until January 25, 2020. It includes online and store location sales, and all flavored and unflavored vape products.

News of the bans comes after officials at the CDC cautioned that it may take some time to find the exact cause of the vaping-related condition.

The House Oversight and Reform Committee’s panel on consumer goods was scheduled to meet today in a hearing on the vaping situation.

UPDATE: September 19, 2019 – 11:30 p.m. PST – Public health officials in Missouri have confirmed the first death in the state attributed to the mysterious vaping-related illness that has struck more than 500 patients in thirty-eight U.S. states, and the U.S. Virgin Islands.

Associated Press reported: “The man,” who was in his mid-40s, and “whose name was not released, had normal lung function before he started using e-cigarettes in May. He developed respiratory problems and was hospitalized August 22 before being transferred on September 4 to Mercy St. Louis, where he died this week, the health department said in a news release. Lung samples taken from the patient determined the death was related to vaping.”

The fatality in Missouri brings the total to eight deaths, including two in California, as well as single cases in Kansas, Illinois, Indiana, Minnesota, and Oregon.

UPDATE: September 19, 2019 – 4:00 p.m. PST – The Food and Drug Administration (FDA) was reported today to have launched a criminal investigation into cases of vaping-related illnesses. The FDA investigation apparently began not long after the first rash of cases surfaced in the U.S. According to Politico.com, the FDA’s Office of Criminal Investigations is currently focused on the product supply chain, though several health officials have said no one product or substance has yet been identified as related to the lung injuries suffered by patients.

Major media networks also today removed e-cigarette advertising from their programming schedules, including CBS, WarnerMedia, and Viacom.

Canadian public health officials have revealed the first case of vaping-related illness identified in the country. A “youth” from London, Ontario, was treated in a local hospital’s intensive care unit and has since recovered. In reaction, several Canadian health advocate organizations have asked for governmental bans of vape products, and for an interim ban order to be issued when the new government convenes in the fall.

UPDATE: September 17, 2019 – 1:00 p.m. PST – A seventh death attributed to vaping-related lung injury in California has been reported. The patient, an unnamed 40-year old male from Tulare County, had a history of vaping. A Health and Human Services spokesperson told media the man also had “some complicating illnesses.”

The fatality is the latest in an outbreak of an unnamed respiratory illness that causes serious lung damage, which has been related to using vape products, especially vape pods, cartridges, and e-cigarettes.

The Centers for Disease Control (CDC) yesterday was reported by news agency Reuters to have activated an Emergency Operations Center to help with its multi-state investigation. The center is a hub for experts, medical investigators, and officials from other government agencies including the Food and Drug Administration (FDA).

UPDATE: September 17, 2019 – 10:30 a.m. PST – In New York, Governor Andrew Cuomo on September 16 announced he would issue an executive order banning flavored e-cigarettes and e-liquids, which many health officials say target underage vape consumers. This follows the first statewide ban in Michigan on flavored vaping products issued at the beginning of the month, and last week’s nation-wide ban proposal from the Trump Administration.

Health officials have confirmed 380 cases of the vaping-related respiratory condition, in 36 states and one U.S. territory so far.

That figure may not include two new cases reported yesterday in the state of Washington or the four new cases announced today in Louisiana.

UPDATE: September 16, 2019 – 10:30 p.m. PST – Democratic California Governor Gavin Newsom today signed an executive order with directives to protect the public, especially underage individuals, from recent incidence of an as yet unidentified serious vaping-related respiratory condition.

Newsom’s order directs for The Department of Tax and Fee Administration to develop recommendations to eliminate illicit and counterfeit nicotine and cannabis vape products from stores; for the California Public Health Department (CPHD) to use $20 million in funding for a campaign to educate youth on the dangers of vaping nicotine or cannabis; will require warning signs on advertising and at retailers; and will create stricter age verification standards for the purchase of tobacco and nicotine products, with the signing of Senate Bill 39.

“As a state, we can no longer stand by as a new generation falls victim to big tobacco, with vaping products that directly target our children,” said California Health and Human Services Agency Secretary Dr. Mark Ghaly in a press release.

“The Governor’s action will raise awareness of the dangers of tobacco products and the risks associated with e-cigarettes and vaping, as well as look at enforcement actions that show Californians the gravity of targeting young people and their health.”

The action follows several states’ officials tightening restrictions on vape products, especially flavored e-liquids and vape pens that appeal to young users.

UPDATE: September 13, 2019 – 3:30 p.m. PST – In a statement released yesterday, the Centers for Disease Control and Prevention has altered its number of confirmed cases of vaping-related lung illness. In place of the 450 suspected cases it was reviewing last week, the agency now cites, “380 cases of lung illness reported from thirty-six states and one U.S. territory.”

The statement went on to say CDC does “not yet know the specific cause of these illnesses.”

UPDATE: September 11, 2019 – 9:45 a.m. PST – In a statement from the Kansas Department of Health and Environment on Tuesday, officials announced the sixth vaping-related death in the epidemic currently sweeping the nation. The decedent was a Kansas resident over the age of 50 whose name has not yet been released.

According to the KDHE announcement, Kansas State Epidemiologist Dr. Farah Ahmed said “the patient had a history of underlying health issues and was hospitalized with symptoms that progressed rapidly.”

The CDC, FDA, and state health departments continue to investigate the VAPI outbreak.

UPDATE: September 7, 2019 – 10:25 a.m. PST – Public health officials in Minnesota have announced the fifth death related to vaping.

The in a media release, officials confirmed, “According to Minnesota State Epidemiologist Dr. Ruth Lynfield, the patient had a history of underlying lung disease and was hospitalized with a severe lung injury that progressed to include other conditions. Investigators looking into the case after the patient died found the lung injury was associated with vaping illicit THC products.”

In related news, NBC4 Los Angeles yesterday reported that officials have referred to the new medical condition as “vaping-associated pulmonary injury,” or VAPI, for short.

UPDATE: September 6, 2019 – 3:09 p.m. PST – The Los Angeles County Department of Public Health today announced the first death in Los Angeles attributed to the vaping-related respiratory condition sweeping the nation. It is the fourth fatality officially confirmed to have been caused by the mysterious illness.

“The Los Angeles Department of Public Health takes this threat seriously and today we’re issuing a warning about the use of these devices as potentially harmful to lung function. We join the Centers for Disease Control to advise people to stop vaping now, until information about what is causing lung damage and death can be understood,” said the Department at a press conference held at 2 p.m. PST on Friday.

Limited information was given about the deceased; only that they were an “older adult,” and then it was clarified the patient was over 55 years of age. They confirmed the Los Angeles patient had vaped THC products.

Officials also made clear that investigations are ongoing, so there has not been “one substance, one product, or a device” that can be singled out. All of those components are currently being examined, they said, with samples of vape products collected from patients.

WASHINGTON, D.C. – Federal and public health officials in several states expressed growing concern today about hundreds of patients that have been affected by a potentially deadly respiratory condition related to vaping e-cigarettes and, apparently, cannabis vape cartridges.

Media reports this morning said federal officials have announced the number of patients affected by “vaping illness” has virtually doubled overnight to a possible total of 450 patients, across thirty-three states.

Public health officials in Indiana today also revealed a third fatality attributed to the vaping-related condition. Their announcement had no information about the patient, except that they were over the age of 18. Indiana officials also told media that there are eight confirmed cases of the condition in the state, and twenty more being investigated.

Associated Press stated in its report on the Indiana fatality, “Health officials said no single vaping device, liquid or ingredient has been tied to all the illnesses. Many of the sickened—but not all—were people who had been vaping THC, the chemical that gives marijuana its high.”

A report today in the New England Journal of Medicine, by Dr. David C. Christiani, M.D., M.P.H., titled Vaping-Induced Lung Injury, said in part, “Mixing of multiple ingredients with primary compounds and potential contaminants may result in in vitro (or even in vivo) production of new agents that may be toxic. E-cigarette fluids have been shown to contain at least six groups of potentially toxic compounds: nicotine, carbonyls, volatile organic compounds (such as benzene and toluene), particles, trace metal elements according to flavor, and bacterial endotoxins and fungal glucans.”

While Dr. Christiani’s report was not focused on cannabis vaping materials only, he did comment that, “The effect of adding ingredients such as THC or CBD to this mix needs to be investigated.” He also referred to the growing numbers of vaping-related cases an “epidemic.”

Yesterday, federal and state officials were reported to be focusing on a common substance, Vitamin E acetate, which had been found in analyzed cannabis vape cartridge samples used by patients in several states. In New York State, which also has seen a recent rash of vaping-related respiratory cases, all the samples collected from patients apparently contained the substance.

U.S. Food and Drug Administration (FDA) investigators in a Thursday phone conference with state public health officials focused on Vitamin E acetate, as described by the Washington Post.

While an innocuous substance, officials said the heating that occurs during the vaping process may change the molecular structure of Vitamin E acetate, resulting in unknown, potentially harmful effects when vaped as an ingredient in liquid vape products.

Oils rich in vitamin E include those derived from nuts, sunflower, wheat germ, safflower, corn, and soybeans. Vitamin E acetate also is an ingredient used in topical skin applications and nutritional supplements.

According to media reports, the FDA sampled twelve nicotine and eighteen cannabis vape products, collected from patients in several states. Vitamin E acetate was allegedly found in ten of the cannabis products.

The Washington Post and other media outlets displayed a photo, sourced form the New York Department of Health, of some of the cannabis vape cartridge products that had been sampled by the FDA. They included packaging for Chronic Carts, Dank Vapes, and a Snoop Dogg G Pen attached to an unidentified vape oil cartridge.

No information was given as to whether the products had been verified as legitimate or where they had been purchased. Officials also cautioned that it is too early in their investigation to make a determination as to the cause of the recent respiratory cases.

FDA comments quickly followed news out of Oregon on Thursday that a second death had been confirmed by officials as vaping-related. The male patient, who died in July, told doctors he had vaped cannabis products purchased at a legal dispensary.

OregonLive.com reported on Wednesday that state health officials are focused on “cannabis oil from two marijuana retail stores and investigators are now trying to find leftover product to analyze it.” They also said that this is the second death in Oregon related to “e-cigarettes.”

Investigators in the Oregon fatality also said it is unknown if the patient used products from both retailers, or if the cannabis oil had been “altered” or mixed with another “homemade” substance.

In Michigan on Wednesday, Democratic Governor Gretchen Whitmer ordered a ban on all flavored e-cigarettes, in an effort to curb vaping among underage users. Michigan is the first to take statewide action, motivated by reports of what Whitmer called a “public health crisis,’” related to vaping.

On August 30, public health officials in the city of Milwaukee, Wisconsin, issued a health alert advisory recommending that residents avoid vaping, especially “THC products containing e-liquid.”

Public health officials in Illinois reported the first vaping-related death on August 23. In the week previous to their announcement, they noted that vaping-related respiratory cases in the state had doubled, with patients all between 17 to 38 years of age.

Several of the Illinois patients also reported to doctors that they had used cannabis vape products, though officials said no specific products had been linked to the cases. Officials in Illinois said also that they had requested assistance from the Centers for Disease Control in investigating the rash of cases, and CDC investigators had arrived in the state.

Symptoms of the condition include cough, shortness of breath, fatigue, fever, anorexia, pleuritic chest pain, nausea, and diarrhea.

Ed. Note: This is a developing news story, more information will be added as it becomes available.

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