CDC investigating reports of counterfeit or mishandled Botox injections in 9 states 

(The Hill) -- Federal agencies and state and local health departments are investigating reports of reactions to injections of counterfeit or mishandled botulinum toxin, commonly known as Botox, across nine states.

The Centers for Disease Control and Prevention (CDC) said 19 people across nine states reported harmful reactions after receiving botulinum toxin shots from unlicensed or untrained individuals or in non-healthcare settings as of April 12. The states include Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington.

Nine people have been hospitalized so far and four people were treated with botulism antitoxin because of concerns it had spread beyond the injection site, according to the CDC. All of the reports came from women ages 25 to 59 years.

The CDC first announced last week that it would launch a multistate investigation into potential counterfeit injections. The agency said symptoms associated with the reports include blurry vision and double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, difficulty breathing and fatigue.

Botulism is a serious illness that occurs when the toxin attacks the body’s nerves, according to the CDC. The agency said that people can prevent illness by getting injections of botulinum toxin only from licensed practitioners.

Those injections include doses of the toxins at levels that are mandated and approved by the Food and Drug Administration (FDA).