Last month, an outbreak of E. coli caused the U.S. Centers for Disease Control and Prevention (CDC) to issue a warning about romaine lettuce. The first casualty of that outbreak was reported Wednesday. There is no recall issued by the FDA, and cleaning the lettuce doesn’t help, which makes it important to understand the symptoms of food poisoning.

Food poisoning is a general term for when a person eats contaminated food. There are more than 250 foodborne diseases, and the CDC estimates 48 million people each year get sick from foodborne illnesses, while 128,000 are hospitalized and 3,000 will die. In the case of exposure to E. coli, a person can feel severe abdominal cramps causing them to go into the fetal position in pain while also dealing with diarrhea, which can start showing signs of blood after 24 hours. Those infected will likely have trouble keeping food down during this time period.

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Infections have been reported in 25 different states.

Since there are so many causes of food poisoning, that also means symptoms can vary. E. coli takes a little longer to affect the body than other foodborne diseases with symptoms showing up about three to four days after exposure. A fever and vomiting may also occur after exposure.

A healthy person suffering from food poisoning can recover on their own with rest and fluids, but it’s advised to see a doctor right away when symptoms start as this particular strain of E. coli is more severe than normal. Food poisoning can be fatal for children, older adults, and individuals with a weakened immune system.

The CDC tracked the source of the infected romaine lettuce to Yuma, Arizona. It advises people to not eat lettuce unless they are absolutely sure it did not come from Yuma. There have been reported cases of E. coli exposure in 25 states so far.

Prior to the E. coli outbreak, in April the FDA issued a recall of 206 million eggs that were tainted with Salmonella.