State and federal officials are investigating reports of hepatitis in infants and children in Clark County, Nevada, linked to the consumption of “Real Water’” brand alkaline water.

In a March 18 press release, Mesa, Arizona-based Real Water announced it had moved to cease the sale and distribution of its Real Water products throughout the U.S. until the issue is resolved, and it has requested retailers immediately pull product from shelves.

“Real Water takes great strides in every way to make sure our product is safe for consumption,” the company said in the release. “Our goal is to diligently work with the FDA to achieve a swift resolution.”

FDA launched an investigation after learning about reports of acute nonviral hepatitis affecting five young children in Nevada, according to Frank Yiannas, FDA’s deputy commissioner for food policy and response. The agency is investigating the matter, in collaboration with local and state partners, as well as the CDC.

Abdominal pain, dark urine, fatigue, fever and yellow eyes/jaundice are some of the symptoms of hepatitis.

“We are advising consumers, restaurants and retailers to not consume, cook with, sell or serve ‘Real Water’ alkaline water until more information is known about the cause of the illnesses,” Yiannas said in a March 16 statement. “We are working to determine how the alkaline water may be related to the illnesses. Although the investigation is ongoing, epidemiologic information currently indicates that this alkaline water product may be the cause of the illnesses. We will provide additional updates as more information becomes available.”

In November 2020, the Southern Nevada Health District received initial reports of five cases of acute nonviral hepatitis. While all five children from four different homes were hospitalized, they have all recovered, the health district said in a March 16 news release. All of the patients reportedly consumed Real Water’s product, and the health district said five other individuals—two adults and three children from two of the four households—reportedly experienced other symptoms as well, including (among others) fatigue, loss of appetite, nausea and vomiting.