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Health Canada says people who vape should get medical attention right away if they’re worried their electronic cigarettes are harming them.

The federal department says there is no sign in Canada of an affliction reported in as many as 25 American states that seems to be linked to vaping, but it is monitoring the situation.

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Most of those who have fallen ill have been teens or adults in their 20s or 30s, hospitalized with severe shortness of breath, vomiting, fever and fatigue. Other symptoms include coughing, chest pain and diarrhea, and signs of infection, such as fevers, that appear without any apparent source.

Some patients have been successfully treated with heavy doses of steroids, a therapy typically used to calm inflammation. Some have narrowly avoided death, but two people, one in Illinois and another in Oregon, have died from lung illnesses.

Health investigators believe there are dozens of possible chemicals inhaled through vaping that could be causing what appears to be a severe inflammatory reaction in the lungs, a condition that looks a lot like pneumonia and that can essentially strangle the afflicted.