One person in California has died as a result of eating romaine lettuce contaminated with E. coli bacteria.
The Centers For Disease Control says an additional 23 people are ill in 10 states since that last update on the outbreak in late April.
That brings the total number of people affected to 121 in 25 states, including South Dakota and Montana.
No one in North Dakota has been affected so far.
The CDC says 52 people are hospitalized, including 14 people who have developed a type of kidney failure.
The outbreak of contaminated romaine lettuce has been traced to the Yuma, Arizona growing region. However, the CDC has yet to identify a specific grower or location in the Yuma area for where the outbreak originated.
The CDC is advising consumers to not eat or buy romaine lettuce unless they can confirm it is not from the Yuma growing region.
You can get more information on the outbreak here.