The Centers for Disease Control and Prevention is now investigating a series of hospitalizations across nine states, including Illinois, linked to mishandled or counterfeit Botox injections.

The CDC said that it, along with local health departments and the Food and Drug Administration, were investigating reports of 19 people who had experienced symptoms from botulism injections provided by those who may not have had the licensing or training to conduct the procedure, or who were doing so in a non-health care setting. In addition, the products provided may have been counterfeit or came from unverified sources.

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At least 60% of those affected were hospitalized and another four needed to receive a botulism anti-toxin out of concern that the toxin may have spread to areas outside the injection site.

What are the symptoms of botulism?

Those affected reported symptoms such as blurry or double vision, fatigue, difficulty breathing or swallowing, slurred speech, drooping eyelids, dry mouth and generalized weakness.

According to the CDC, all who reported symptoms were women between the ages of 25 and 59, with all but one receiving the injection for a cosmetic purpose.

Illinois and other stakes warn of mishandled or fake Botox

The Illinois Department of Public Health reported last week that at least two people in LaSalle County had reported similar symptoms following a procedure with a licensed nurse acting outside her professional authority. They also warned that medical facilities needed to be on the lookout for others with the same condition.

Other states affected include Colorado, Florida, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington.

The CDC recommends that people looking to receive Botox injections verify if the medical facility they choose has those licensed to provide Botox injections and if the product provided is approved by the FDA. They also ask that people experiencing symptoms of botulism to contact their medical provider or go to the hospital immediately.

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A judge on Monday ordered a psychiatric evaluation for a northern Illinois man charged with killing four people and injuring seven others by stabbing, beating and driving over them.

Winnebago County Judge Debra Schafer ordered the evaluation for Christian Soto when the 22-year-old man appeared in court by video link for a scheduled arraignment on charges of first-degree murder.

Soto’s arraignment now is scheduled for May 17.

Assistant State’s Attorney Ken LaRue said the case would go before a grand jury on Friday.

Soto’s attorney, Glenn Jazwiec, said he had no comment on the judge’s order.

Authorities have said Soto was behind a series of frenzied attacks on March 27 at multiple addresses in a Rockford neighborhood, but they haven’t determined a motive.

The Winnebago County coroner has identified those killed as 63-year-old Romona Schupbach; 23-year-old Jacob Schupbach; 49-year-old Jay Larson; and 15-year-old Jenna Newcomb.

Winnebago County State’s Attorney J. Hanley has said Soto told police after his arrest that he had smoked marijuana with Jacob Schupbach and believed the drugs “were laced with an unknown narcotic” that made him paranoid.

Soto first fatally stabbed Schupbach and his mother, then he beat, stabbed and used a truck to run over Larson, who was working as a mail carrier, authorities said. He next wounded three people inside one home, and beat Newcomb, her sister and a friend with a baseball bat inside another home, according to authorities. The attacks happened within a matter of minutes.

Winnebago County sheriff deputies arrested Soto as he fled from another home where he had stabbed a woman but had been slowed down by a driver who stopped to intervene, authorities said.