When a person becomes infected with the bacteria, it can take two to three weeks before a report to the CDC.
The disease appears to have been spread from romaine lettuce grown in the Yuma region of Arizona.
Health officials announced on Friday that five people have now died after consuming tainted lettuce from Arizona, making this the nation's largest E. coli outbreak in a decade. It is unlikely that any romaine lettuce from the Yuma growing region is still available in people's homes, stores, or restaurants due to its 21-day shelf life. At least 89 were hospitalized. The four additional deaths were reported from Arkansas, Minnesota and NY. Canadian health officials also recently identified E. coli cases in several provinces that could potentially be linked to the outbreak in the United States.
Officials said that first illness began sometime between March 13 and May 12.
The recent E. coli outbreak is the most severe to hit the US since 2006, when three people died in an outbreak linked to uncooked spinach.
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When eaten, E. coli can cause diarrhoea, vomiting and even kidney failure in severe cases. While almost 90 percent of those who fell ill reported eating romaine lettuce in the week before they were sickened, some told the CDC that they did not personally eat the lettuce but were in close contact with somebody who did.
Romaine lettuce grows near Soledad, California, U.S., May 3, 2017.
Almost half of those who became ill had to be hospitalized.