A deadly E. coli outbreak linked to chopped onions on McDonald’s Quarter Pounder burgers has sickened 104 people in 14 states, federal health officials said in an update Wednesday.

At least 34 people were hospitalized and four developed hemolytic uremic syndrome (HUS), a serious condition that can cause kidney failure. An 88-year-old man who lived in Grand JunctionColorado, died, as previously reported. The illnesses began in late September, and the most recent outbreak occurred on October 21, according to TO US Food and Drug Administration.

In late October, McDonald’s said Quarter Pounders – without chopped onions – would be back on the menus of hundreds of affected restaurants after tests ruled out beef patties as the source of the outbreak.

The hamburger chain pulled the burgers from restaurants in several states after the outbreak has been announced.

FDA and Colorado officials collected onion and environmental samples from McDonald’s stores and distribution centers. A sample of the recalled onions tested positive for E. coli but did not match the outbreak strain.

Onion supplier Taylor Farms recalled yellow onions in the wake of the outbreak, and McDonald’s reintroduced cut onions from another supplier.

“There does not appear to be an ongoing food safety issue related to this outbreak at McDonald’s restaurants,” the FDA said.

It usually takes three to four weeks to determine if a sick person is part of an outbreak. Most people infected with toxin-producing E. coli experience severe stomach cramps, diarrhea, and vomiting. Most recover without treatment after five to seven days.

People are advised to call their healthcare provider if they have eaten a McDonald’s Quarter Pounder and have severe problems. symptoms of E. coli.

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