Tennessee reported its first death related to electronic cigarette use on Thursday.

Health officials across the country have been alarmed by reported cases of serious respiratory illness linked to e-cigarette use, also known as vaping.

Officials said the patient in Nashville had a serious respiratory disease.

Nearly 1,300 lung injury cases and 26 deaths have been documented across the U.S. as of Oct. 8, according to the Centers for Disease Control and Prevention. The majority of patients reported vaping with products containing THC — the psychoactive component of marijuana — but the exact cause of the illness has not been determined.

CDC also reports some patients said they only used nicotine-containing products and others combined THC and nicotine products.

As of Thursday, 53 cases, including the one death, have been reported in Tennessee, according to the state’s department of health.

In Virginia, state officials say they’ve seen 60 confirmed cases of lung injuries, including one reported death.

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