The US Centers for Disease and Control Prevention (CDC) broadcast a food safety alert at 2:30 p.m. It is now advising people throw away whole heads of romaine in addition to chopped romaine.
Canada's Public Health Agency also reported 18 people became ill from the same strain of E. coli. Of those, 13 people have been hospitalized and one person has developed hemolytic uremic syndrome, which is a type of kidney failure.
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The latest illnesses linked to the lettuce began between October 8 and October 31.
Symptoms, which appear within 10 days of consuming contaminated food, may include nausea, vomiting, headache, mild fever, severe stomach cramps and watery or bloody diarrhea.
The Canadian Food Inspection Agency says it's working with USA authorities to determine the source of the romaine lettuce those who got ill were exposed to. But he says suppliers can help by withdrawing romaine products until the contamination can be identified.
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There is another E. coli outbreak in the United States, and the agency has traced it back - yet again - to the usual suspect: the crunchy and leafy green served across the country.
This investigation is ongoing, and the CDC will provide more information as it becomes available.
Wash and sanitize drawers or shelves in refrigerators where romaine was stored.
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The announcement comes two days before Thanksgiving, so people planning their holiday meals may need to adjust menus accordingly. California and MI have the most reported cases (10 and 7, respectively). Children under age 5 and adults over age 65, along with people who have weakened immune systems, are most at risk for serious complications after ingesting the bacteria.