The Centers for Disease Control and Prevention and Food and Drug Administration are investigating adverse effects in 22 people in 11 states who received botulinum toxin injections that were counterfeit or administered in non-healthcare settings or by unlicensed or untrained individuals. Eleven individuals were hospitalized. All but two of the injections were for cosmetic purposes. CDC said clinicians should consider the possibility of adverse effects from botulinum toxin injections in patients presenting with localized paralysis and immediately contact their state or local health department if they suspect botulism, a rare and sometimes fatal illness caused by botulinum toxin. 

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