McDonald’s Quarter Pounder hamburgers have been linked to an E. coli outbreak spanning ten states, the Centers for Disease Control and Prevention (CDC) warned Tuesday.

The CDC said in an alert that it has launched an investigation after 49 people reported getting sick eating Quarter Pounders. There have been ten hospitalizations and one death linked to the outbreak.

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“This is a fast-moving outbreak investigation,” the CDC said in a statement. “Most sick people are reporting eating Quarter Pounder hamburgers from McDonald’s and investigators are working quickly to confirm which food ingredient is contaminated.”

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The notice added that McDonald’s has pulled ingredients for Quarter Pounders, and those hamburgers temporarily won’t be available for sale in some states. 

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McDonald’s North America chief supply chain officer Cesar Piña said in an internal statement that the company is “taking swift and decisive action” to address the outbreak, and reported that “The initial findings from the investigation indicate that a subset of illnesses may be linked to slivered onions used in the Quarter Pounder and sourced by a single supplier that serves three distribution centers.”

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McDonald’s USA President Joe Erlinger issued a video message addressing the outbreak.

The CDC did not list every state where cases have been reported, but said most illnesses linked to the outbreak so far are in Colorado and Nebraska.

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McDonald’s said it has removed the Quarter Pounder from Colorado, Kansas, Utah and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.

The CDC advises that anyone who experiences severe E. coli symptoms such as high fever, diarrhea, vomiting or dehydration after eating a Quarter Pounder should call their healthcare provider.

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