At least 19 women in nine states fell ill after receiving Botox injections, according to the CDC

At least 19 women in nine states fell ill after receiving Botox injections, either because they were administered by people without license or training to do so or because they received them in “non-healthcare environments,” such as homes or spas, the Centers for Health reported Monday. Disease Control and Prevention (CDC).

Nine of the 19 patients were hospitalized, according to the CDC. Four “were treated with botulinum antitoxin due to concerns that the botulinum toxin may have spread beyond the injection site.”

Botox uses a purified form of a neurotoxin called botulinum toxin that prevents muscles from moving for a period of time. The product is usually used to prevent or relieve facial wrinkles. When the toxin is found in food, it can cause widespread paralysis and even death.

But when injected carefully, botulinum toxin is generally considered safe. Too much in the wrong places can be harmful, according to the CDC.

Cases have been detected in Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington. No deaths have been reported.

It is unclear whether the reactions were due to fake products, contamination or poor sanitation practices. A CDC investigation is ongoing, the agency said.

For its part, the Food and Drug Administration (FDA) declared on Friday that it was participating in the investigation.

Warnings about medical procedures at unregulated spas are increasing. Colorado health officials told NBC News they are investigating a case of a botulism-like illness after an unlicensed health provider injected a patient with what was believed to be botulinum toxin. The Illinois patients received shots from a nurse “who was performing work beyond her authority,” according to the state Department of Public Health.

Adverse reactions to botulinum toxin injections include:

  • Blurred or double vision.
  • Drooping eyelids.
  • Difficulty swallowing or breathing.
  • Dry mouth.
  • Difficulty speaking.
  • Fatigue and weakness.