(NewsNation) — Health officials are investigating reports of harmful reactions to Botox injected by unqualified people in nine states.

As of April 12, 19 people reported reactions after having Botox injected in Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee and Washington, according to the U.S. Centers for Disease Control and Prevention.

Reported effects include blurred or double vision, drooping eyelids, difficulty swallowing, dry mouth, slurred speech, difficulty breathing, fatigue and generalized weakness.

Nine people were hospitalized and four were treated with botulism antitoxin out of concern that the substance would spread beyond the injection site.

Results were negative for all five people who were tested for botulism.

Each of the reports came from females ages 25-59, with a median age of 39 years old. Each of their injections were either administered by unqualified injectors or outside of a health care setting, including homes and spas, according to the CDC.

Anyone seeking Botox injections should check their provider’s licensure and training as well as ask if the product is FDA-approved and comes from a reliable source.

While botulism is a dangerous illness, a purified form of the bacteria is approved by the Food and Drug Administration and is used in Botox.

Botox is primarily known for its cosmetic use to reduce wrinkles, but the injections also have medical uses. Conditions that can be treated with Botox include muscle spasms, bladder disorders, temporomandibular joint syndrome, migraines and more, with recent research also suggesting it could be used to treat depression.

NewsNation digital producer Stephanie Whiteside contributed to this report.