A fourth person has died from a vape-related lung illness, officials from the Centers for Disease Control and Prevention (CDC) reported. As of Friday, 450 suspected cases of vape-related respiratory illnesses have been reported in 33 states and one territory, the Washington Post reported. A fifth death is currently under investigation.

“The severity of the illness and the recent increase in the incidence of this clinical syndrome indicates that these cases represent a new or newly recognized and worrisome cluster of pulmonary disease related to vaping,” Wisconsin and Illinois health officials said in a report.

Officials with the CDC and the Food and Drug Administration (FDA) have yet to single out a product or brand that may be causing the outbreak of severe pulmonary illnesses, though New York state health officials have identified vitamin E acetate in cannabis vaping products as a possible culprit in some cases. However, some research casts doubt on that assumption. Mitch Zeller, director of the FDA Center for Tobacco Products said the investigation into the illnesses is still in the “critical fact-gathering stage.”

The first vaping-related death was reported by Illinois health officials Aug. 23. On Wednesday, Oregon health officials linked the death of a middle-aged patient in July to vaping. The third death was confirmed Thursday by Indiana health officials. On Friday, Minnesota health officials linked the death of a 65-year-old patient to lung injuries related to vaping.

Most of the people who have developed the illness have been young and otherwise healthy. They reported symptoms such as coughing, chest pain and shortness of breath. According to a joint report by Wisconsin and Illinois health officials of 53 patients who developed the lung illness, all but three of the 53 were admitted to the hospital, and more than half required intensive care.

Some patients reported using vaping juice with THC, but some also reported using various brands of nicotine in a variety of flavors. Some patients said they only used THC products while a few said they used nicotine-only products. Health officials said they are focusing on whether some of the vape juice used by those sickened contained contaminants or counterfeit substances.

Jennifer Layden, chief medical officer at the Illinois Department of Health, said that there was an increase of cases of severe respiratory illness at emergency departments in the state beginning in May and June. “That would suggest that it’s a new phenomenon.”

Beasley Allen lawyers Joseph VanZandt and Sydney Everett are currently representing several individuals who are suing JUUL for the negative impact its products have had on their lives.

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