Three cases of vaping-related illness in northeast North Dakota this past week -- indicating a potential cluster -- has been confirmed by the North Dakota Department of Health, according to a statement released on Tuesday, Oct. 15.

Reported symptoms include cough, fatigue, dizziness, headache, vomiting and diarrhea, chest pain and worsening difficulty breathing, sometimes requiring intensive care. Some patients received antibiotics but did not have a positive response, according to the state Department of Health.

"The North Dakota Department of Health is still investigating the cases in the potential cluster and will continue to monitor the situation in the northeast part of the state, as well as across North Dakota," said Kodi Pinks, assistant director at the Office of the State Epidemiologist.

To date, the Department of Health has received seven confirmed, five probable and three suspected reports of severe respiratory illness in patients with a history of vaping use. Similar to nationwide trends, most, but not all of the confirmed or probable cases in North Dakota reported a history of using tetrahydrocannabinol (THC)-containing products.

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“We continue to collect data and are working closely with the CDC to aid in the investigation,” said Dr. Tracy Miller, state epidemiologist with the Department of Health. “It is vital that individuals who have experienced symptoms and have a history of vaping either talk to their health care provider or fill out the survey on our website.”

As of Oct. 8, 49 states, 1,299 potential cases of severe respiratory illness from vaping or e-cigarette use among teenagers and adults. Twenty-six deaths have been confirmed in 21 states, according to the Centers for Disease Control and Prevention, which, in its Oct. 11 issue of Morbidity and Mortality Weekly Report, called the illness EVALI, or "e-cigarette or vaping product use associated lung injury."