(WKBN) – According to the Ohio Department of Health (ODH), many people affected by the E. coli outbreak in Ohio and Michigan reported eating at Wendy’s before getting sick.

ODH says those people reported eating burgers and sandwiches with romaine lettuce at Wendy’s locations in Ohio, Michigan and even Pennsylvania before getting sick.

ODH also says Wendy’s is taking precautionary measures by removing romaine lettuce from the menu for the time being.

Investigators are working to confirm if the lettuce was the source of the outbreak and if it was served anywhere else.

Nineteen cases have been reported in Ohio:

  • Clermont County – 1
  • Cuyahoga County – 2
  • Franklin County – 1
  • Lorain County – 3
  • Lucas County – 2
  • Mahoning County – 2
  • Summit County -1
  • Wood County – 7

Eleven of those affected are men and eight are women, ranging in age from eight to 82 years old.

Four people have been hospitalized in Ohio but no deaths have been reported overall.