The CDC announced Tuesday an outbreak of E. coli from McDonald’s Quarter Pounders that resulted in one death, at least 49 illnesses, and 10 hospitalizations.

The sickness was reported in 10 states, most of which occurred in Colorado (26 cases) and Nebraska (nine cases). The infections occurred between September 27 and October 11. The ages of those infected range from 13 to 88 years old. An older adult died in Colorado while one person developed hemolytic uremic syndrome, which can cause kidney failure.

The CDC called it “a fast-moving outbreak investigation.”

“McDonald’s and investigators are working quickly to confirm which food ingredient is contaminated,” the agency said in its notice. “McDonald’s has pulled ingredients for these burgers, and they won’t be available for sale in some states.”

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McDonald’s said initial findings show a subset of illnesses may be linked to slivered onions used in the Quarter Pounder and sourced by one supplier that serves three distribution centers.

In response, McDonald’s has instructed compromised restaurants to remove the product from their supply chain, pause the distribution of slivered onions, and temporarily cut the Quarter Pounder from the menu. These areas include Colorado, Kansas, Utah, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.

“Across the McDonald’s System, serving customers safely in every single restaurant, each and every day, is our top priority and something we’ll never compromise on,” Cesar Piña, North America chief supply chain officer, said in a statement.

Shares of McDonald’s were falling about 6 percent pre-market Wednesday.

McDonald’s U.S.A president Joe Erlinger responded to the outbreak in a video.

In the meantime, the burger chain is working with suppliers to replenish supplies for the Quarter Pounder in the coming weeks. Other beef products on the menu are unaffected. Fresh slivered onions are primarily used on Quarter Pounder hamburgers and not other menu items.

The CDC instructs individuals to call their healthcare provider if they ate a Quarter Pounder and have E. coli symptoms, such as diarrhea and a fever higher than 102 degrees; bloody diarrhea; so much vomiting that you can’t keep liquids down; and signs of dehydration. Symptoms typically start three to four days after swallowing the bacteria.

The agency noted that the true number of sick people is likely much higher and that the outbreak may not be limited to the states with known illnesses. This is because many people recover without medical care and are not tested for E. coli.

TD Cowen analyst Andrew Charles wrote franchisee checks suggested the issue seemed largely contained. Still, a short-term impact on sales should expected given past comparisons. Using food safety events at Chipotle (2015) and Jack in the Box (1993) as baselines, Charles estimated every 1 percent annualized change in U.S. same-store sales would lead to a $0.09 EPS impact, with the worst-case scenario being a $0.37 Q4 downturn. 

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