The first death has been reported in a national food poisoning outbreak linked to romaine lettuce.

The death was reported in California, but state and federal health officials did not immediately provide any other details.

The Centers for Disease Control and Prevention updated its numbers on the outbreak Wednesday, revealing that 121 people had gotten sick in 25 states. At least 52 people have been hospitalized, including 14 with kidney failure, which is an unusually high number of hospitalizations.

The CDC also added Kentucky, Massachusetts and Utah to the states with reported cases.

Health officials have tied the E. coli outbreak to romaine lettuce grown in Yuma, Arizona, which provides most of the romaine sold in the U.S. during the winter.

The growing season in Yuma ended about a month ago, said the University of Arizona’s Russell Engel, the director of Yuma County’s cooperative extension service.

But even if no one is eating tainted lettuce now, case counts may still rise because there’s a lag in reporting. The first illnesses occurred in March, and the most recent began on April 21, the CDC said.

Most E. coli bacteria are not harmful, but some produce toxins that can cause severe illness. People who get sick from toxin-producing E. coli come down with symptoms about three to four days after swallowing the germ, with many suffering bloody diarrhea, severe stomach cramps and vomiting.

Most people recover within a week, but some illnesses can last longer and be more severe.

(AP)