Health investigators have identified chopped romaine lettuce from Arizona as the probable culprit of an 11-state E. coli outbreak that has sickened at least seven people in New Jersey as well as people in New York and Connecticut.

The New Jersey Department of Health issued an update on the probe Friday, saying the Centers for Disease Control and Prevention and the U.S. Food and Drug Administration traced the likely source back to lettuce grown in Yuma, but neither agency has identified a grower, supplier, distributor or brand.

Consumers who have bought romaine lettuce – including salads and salad mixes containing romaine lettuce – are advised to throw it away, even if some of it was eaten and no one has gotten sick.

“If you don’t know if the lettuce is romaine, throw it away. Before purchasing romaine lettuce at a grocery store or eating it at a restaurant, consumers should confirm with the store or restaurant that the romaine lettuce did not come from the Yuma, Arizona growing region,” the NJ Department of Health said.

As of April 13, 35 cases have been reported in 11 states. Twenty-two people have been hospitalized, the CDC says. The seven cases in New Jersey include four in Hunterdon County and one each in Monmouth, Sussex and Somerset counties. The sick range in age from 12 to 84 and most are women.

There are eight cases in Idaho, two in Connecticut, nine in Pennsylvania, two in New York, two in Ohio and one each in Illinois, Michigan, Missouri, Virginia and Washington, the CDC says.

Health officials say the outbreak started in late March. Though no deaths have been reported, at least six people have been hospitalized with one developing hemolytic-uremic syndrome, a type of kidney failure.

Symptoms vary and can range from mild to severe diarrhea to nausea and vomiting. Usually there is little or no fever present. E. coli can spread from an infected person, contaminated food or water, or by touching contaminated surfaces, the CDC says. It is very contagious and can spread quickly in places such as daycare centers and cruise ships.

“Individuals with this infection usually get better within about 5 to 7 days, however some illnesses can be serious or even life-threatening,” New Jersey Health Commissioner Dr. Shereef Elnahal said in a statement. “Anyone experiencing symptoms of this illness should see a healthcare provider.”

(AP)