Ongoing investigation

cases have been reported from 25 states, and additional reports of pulmonary illness are under investigation.

While all patients reported using e-cigarette products prior to their symptoms appearing, no one product or device has been identified as a common link in the cases yet, the agencies said.

However, many of the patients have reported vaping products containing tetrahydrocannabinol, or THC — the ingredient in marijuana that gets people high. Others, however, say they used nicotine products only. Laboratory testing is underway to determine the exact contents of the vape products.

“At this time, the specific substances within the e-cigarette products that cause illness are not known and could involve a variety of substances,” the agencies said.

The vast majority of cases under investigation in New York involve people who reported vaping cannabis-based products, said state Health Department spokeswoman Jill Montag.

“However, we are also investigating cases in which people report using both cannabis and nicotine products,” she said.

Testing by the state’s Wadsworth Center has identified high levels of vitamin E acetate — an ingredient typically found in skin care products and dietary supplements — in nearly all of the cannabis samples provided by patients. The samples came from different brands and different parts of the state, Montag said.

“This vitamin E acetate is never found in NYS Medical Marijuana Program-authorized vape samples and is now the focus of the investigation of potential causes of vaping-associated respiratory illnesses,” she said.

Wadsworth will continue to test all product samples it receives as the investigation continues, Montag said.

Although little is known about the long-term effects of ecigarette use — which is particularly popular among teens, young adults and former smokers — the sudden onset of severe respiratory illnesses this summer has some experts doubtful that legal e-cigarette products are to blame.

In an interview with the New York Times, former FDA commissioner Scott Gottlieb guessed that the investigations will lead health officials to illegal products.

“It’s not like the major manufacturers have suddenly changed their ingredients,” he said. “It’s probably something new that has been introduced into the market by an illegal manufacturer, either a new flavor or a new way to emulsify THC that is causing these injuries.”

Investigators are looking into the brands and types of vaping products used, as well as where they were obtained and how they were used. They are also analyzing devices for specific ingredients and substances associated with e-cigarette use, along with possible contaminants.

The FDA has received about 80 samples for laboratory testing so far, and is analyzing the contents for nicotine, THC and other cannabinoids, and other chemicals and ingredients.

The CDC has also released a standardized case definition and interview questionnaire to clinicians in hopes of standardizing information collected at the state level.

So far, patients have reported a gradual start of symptoms, including breathing difficulty, shortness of breath and/or chest pain before hospitalization. Some cases reported mild to moderate gastrointestinal illness including vomiting and diarrhea, or other symptoms such as fever or fatigue.

Until more information is available, medical professionals cannot even be sure that the symptoms stem from a common cause.

“Even though cases appear similar, it is not clear if these cases have a common cause or if they are different diseases with similar presentations,” the CDC and FDA said, “which is why our ongoing investigation is critical.”

Health officials are urging e-cigarette users to monitor themselves for the symptoms listed above and to promptly seek medical attention if health concerns arise.