Officials with the California Department of Public Health (CDPH) issued a warning Wednesday to consumers seeking Botox injections and to healthcare providers, saying counterfeit Botox has been found in multiple states.

In a statement, the agency said injections of the counterfeit product being done in unlicensed and non-medical settings have already caused hospitalizations and other serious reactions. Last month, the U.S. Centers for Disease Control and Prevention (CDC) said counterfeit Botox had sickened 22 people in 11 states, including California.

“Counterfeit or incorrectly administered Botox, even in small amounts, can result in serious health problems and even death,” California Public Health Officer Dr. Tomas Aragon said in a statement.

CDPH said it is working closely with the U.S. Food and Drug Administration (FDA) and the CDC, along with other state health departments in the FDA’s ongoing investigation.

Aragon urged consumers to get the injections from licensed and trained professionals in healthcare settings. Consumers should not purchase Botox online or through unlicensed individuals.

Packaging of counterfeit Botox, which has been blamed for hospitalizations and adverse reactions.

Health officials said California allows Botox treatments to be performed by a physician, a registered nurse, or a physician assistant under the supervision of a doctor. If in doubt, consumers should not get the Botox shots.

CDPH said authentic Botox is manufactured by AbbVie Inc., and the FDA-approved product lists the active ingredient as “OnabotulinumtoxinA” on the outer carton vial. No adverse health effects have been reported with the FDA-approved product.

The counterfeit product is labeled “Botulinum Toxin Type A,” comes in 150-unit doses, and contains lot number C3709C3.

Symptoms of counterfeit Botox are similar to botulism poisoning and include drooping eyelids, difficulty swallowing, dry mouth, slurred speech, difficulty breathing, fatigue, and generalized weakness.

Anyone who may have symptoms of botulism poisoning is urged to contact their healthcare provider or go to the emergency room immediately.

Consumers can report suspected counterfeit Botox products through the FDA website or by calling 1-800-551-3989. Reports can also be sent to the Consumer Complaints section of the CDPH website.

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