CDC, several state and local health departments, and the U.S. Food and Drug Administration (FDA) are investigating reports of harmful reactions among people who received injections of counterfeit or mishandled botulinum toxin (commonly called “Botox”).

As of April 18, 2024, a total of 22 people from 11 states have reported harmful reactions after receiving botulinum toxin injections from unlicensed or untrained individuals or in non-healthcare settings, such as homes and spas. Harmful reactions occurred on dates ranging from November 4, 2023, to March 31, 2024. States reporting these reactions include California, Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, Texas, and Washington.

Public health and regulatory officials have found that some people received injections with counterfeit products or products with unverified sources. Investigation into the sources of these products is ongoing.

More information about the counterfeit products, including signs of counterfeit versions, may be found on FDA’s website.

People have reported experiencing

  • Blurry vision and double vision
  • Drooping eyelids
  • Difficulty swallowing
  • Dry mouth
  • Slurred speech
  • Difficulty breathing
  • Fatigue
  • Generalized weakness

Of 20 people with information available, 11 (55%) people were hospitalized and 6 (27%) were treated with botulism antitoxin because of concerns that the botulinum toxin could have spread beyond the injection site. Of seven people tested for botulism, six people had negative results. Results are pending for one person.

All reports came from people identifying as females, ranging in age from 25 to 59 years, with a median age of 41 years. Twenty (91%) people reported receiving botulinum toxin injections for cosmetic purposes. All people reported receiving these injections from unlicensed or untrained individuals or in non-healthcare settings, including homes and spas.