CASPER, Wyo. – Wyoming is among 10 states reporting illnesses of E.coli likely caused by people eating Quarter Pounder hamburgers.

According to the Centers for Disease Control, there have been 49 reported cases, 10 hospitalizations and one reported death from the outbreak, as of Tuesday evening. They expect reports to grow rapidly. Wyoming has reported up to three cases, with most of the outbreaks and one death taking place in Colorado, according to the CDC outbreak map.

The CDC described the early reports as a “fast-moving outbreak” where most of the people who became ill reported eating Quarter Pounders. McDonald’s has stopped selling Quarter Pounders in Wyoming, along with Colorado, Kansas, Utah, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico and Oklahoma.

The CDC said it’s not yet known which specific ingredient caused the outbreak, but fresh slivered onions and the beef patties are a focus. McDonald’s said in a statement that the specific fresh onions are used primarily on Quarter Pounders, and that other items on the menu are unaffected.

The New York Times quoted a personal injury lawyer who said onions can be notoriously difficult to grow cleanly, and have been linked to other food-borne illnesses.

E.coli bacteria contamination can cause very serious symptoms, such as severe stomach cramps, bloody diarrhea and vomiting, according to the CDC. Symptoms usually start some 3 to 4 days after eating the bacteria, and recovery taking five to seven days. Some victims can develop serous kidney issues and require hospitalization, they said.

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