(The Hill) – The Biden administration is conducting a multi-state investigation into illnesses with potential links to injections of botulinum toxin, also known as Botox, in at least two states. 

The Botox injections were conducted in “non-medical settings,” and the source of the products are not yet known, a spokesperson for the Centers for Disease Control and Prevention (CDC) confirmed to The Hill. 

The CDC is working with the health departments in Tennessee and Illinois, where illnesses similar to Botulism have been reported in several patients, the spokesperson said. 

Botulism is a serious illness prompted by a toxin known as clostridium botulinum that targets the body’s nerves, according to the CDC.  Symptoms usually include weaker eye, facial and throat muscles, which can spread to the neck, arms, torso, and legs. It can also weaken one’s muscles and prompt difficulty in breathing and in some cases, death.  

The illness is often treated with an antitoxin, the CDC added. 

Botox injections have small doses of the toxins at levels that are mandated and approved by the Food and Drug Administration (FDA)

Health officials in Illinois this week warned healthcare facilities and hospital emergency departments to look out for symptoms after two cases were reported from people who received injections of Botox, or a “ similar, possibly counterfeit product.” 

The Illinois Department of Public Health said the two cases experienced symptoms akin to botulism including blurred or double vision, droopy face, fatigue, shortness of breath, difficulty breath and a hoarse voice. Both individuals were hospitalized and received injections from a licensed nurse in LaSalle County, Ill., “who was performing work outside her authority,” the department said. 

Four patients in Tennessee also experienced botulism-like symptoms, the state’s Department of Health announced last week. State health officials said its investigations with the CDC and FDA have raised concerns about the use of counterfeit products or those administered in “non-medical settings.” 

All four patients went to a healthcare provider and two were hospitalized, the Tennessee Department of Health added. 

The CDC noted “laboratory-confirmed” cases of botulism after receiving Botox injections are “rare.” 

“Cosmetic injections should be an FDA-approved product, administered by licensed providers and in licensed settings,” the CDC spokesperson said.