Romaine lettuce that was sold in 23 states  may be contaminated with dangerous E. coli O145 bacteria and has been recalled.

Authorities have reported 19 cases of E. coli O145  in Michigan, Ohio, and New York. Twelve people have been hospitalized, including three with life-threatening hemolytic uremic syndrome (HUS) caused by the bacterium.

Several lines of evidence — including detection of bacteria in an unopened package of Freshway Foods shredded Romaine lettuce — point to Freshway Foods wholesale Romaine lettuce products.

Freshway Foods has recalled all products containing Romaine lettuce with a use-by date of May 12 or earlier. These products were sold wholesale to restaurants and supermarkets under the Freshway or Imperial Sysco brands.

The recall does not include bagged or prepackaged Romaine or lettuce mixes containing Romaine. However, the lettuce may be found in supermarket salad bars and delis.

Freshway Foods is advising consumers not to eat “grab and go” salads sold in store salad bars and delis at Kroger, Giant Eagle, Ingles Markets, and Marsh stores.

Symptoms of infection with harmful E. coli may range from none to mild diarrhea to severe complications. The acute symptoms include severe abdominal cramps and diarrhea, which may be bloody. Patients may progress to serious complications, such as kidney damage. The FDA and the CDC encourage anyone with these symptoms to contact his or her health care provider immediately.

The states in which the lettuce was sold are Alabama, Connecticut, District of Columbia, Florida, Georgia, Illinois, Indiana, Kansas, Kentucky, Maryland, Massachusetts, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, Tennessee, Virginia, West Virginia, and Wisconsin