The Centers for Disease Control and Prevention announced an E. coli outbreak that may be connected to McDonald’s Quarter Pounders.

The CDC said “specific ingredient has not yet been confirmed as the source” but most of the people who were sickened said they had eaten Quarter Pounders from McDonald’s.

Officials are trying to determine if the onions used on the burgers or the meat in the beef patty were contaminated, but officials said preliminary information shows that the outbreak came from the slivered onions, the CDC said. Diced onions used on other products are not part of the outbreak/

McDonald’s in Colorado, Kansas, Utah, Wyoming, Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico and Oklahoma have stopped using Quarter Pounder slivered onions and beef patties temporarily, the CDC said.

Overall, there have been 49 illnesses, 10 hospitalizations and one death connected to the E. coli outbreak. The last illness happened on Oct. 11.

McDonald’s president Joe Erlinger appeared on the “Today” show considering the CDC’s food safety alert, saying he believed the company can ”restore confidence” with its customers.

“We are very confident that you can go to McDonald’s and enjoy our classics. We took swift action yesterday to remove the Quarter Pounder from our menu. This was swift and decisive action by us,” Erlinger said, according to CNBC.

He believes that whatever product made people sick it “very likely worked itself through that supply chain already.”

McDonald’s is not the first fast food restaurant to deal with an E. coli outbreak. Chipotle Mexican Grill and Jack in the Box each dealt with similar issues in 2015 and 1993 respectively, but those outbreaks hurt the companies, Reuters reported. It took Chipotle a year and a half to rebound while Jack in the Box had four quarters of slow sales.

As for McDonald’s, it will depend on how widespread the outbreak ends up becoming, Reuters said. The company was already dealing with slow sales in July.

E. coli is a mostly harmless bacteria that live in the intestinal tract. If someone consumes E. coli-contaminated food or drink, they can get a mild to severe gastrointestinal illness. It can become life-threatening depending on the strain.

Symptoms of E. coli include:

• Severe stomach cramps
• Diarrhea
• Fever
• Nausea
• Vomiting

The symptoms can appear in a few days or up to nine days after eating or drinking something that was contaminated, the CDC said.

In extreme cases, depending on what strain was present, a person can have bloody diarrhea, potential kidney failure, high blood pressure, chronic kidney disease or neurological problems. Because of the wide-ranging symptoms, if someone suspects they’ve been exposed to E. coli and have symptoms, they should contact their health care provider.

You can prevent illnesses by:

• Washing hands with warm water and soap for 20 seconds before and after handling raw food
• Wash anything that came in contact with contaminated foods
• Sanitize anything that came in contact with contaminated foods
• Wipe up spills immediately
• Prevent cross-contamination with a pet’s food. Pick up and wash pet food dishes when they are done eating.

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