The Illinois Department of Public Health (IDPH) has alerted healthcare facilities and especially hospital emergency departments to be on a heightened lookout for patients who present with symptoms similar to botulism following a cluster of two cases reported in Illinois of people who received injections in LaSalle County of Botox or a similar possibly counterfeit product. IDPH is working with the LaSalle County Health Department and the Illinois Department of Professional Regulation (IDFPR) on the investigation of the cluster. A similar cluster was also reported by the Tennessee Department of Health and IDPH is in contact with the CDC and FDA regarding this investigation. The two individuals in Illinois reported symptoms similar to botulism such as blurred/double vision, droopy face, and fatigue, shortness of breath, difficulty breathing, and hoarse voice following injection with either Botox or a possibly counterfeit version of the product. Both individuals in Illinois required hospitalization. Both had received injections from a licensed nurse in LaSalle County who was performing work outside her authority. In Illinois, the injection of botulinum toxin, the key ingredient in Botox, is a practice of medicine that may only be performed by certain licensed professionals who are licensed and regulated by IDFPR. Botulism is a rare, but potentially deadly illness characterized by muscle paralysis. Botulism is caused by a nerve toxin that is produced by a bacterium called Clostridium botulinum found in nature, which is an ingredient in Botox and other similar substances used for cosmetic reasons. For more information, visit www.dph.illinois.gov.