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For a more detailed review of the respiratory effects of e-cigarettes, see Gotts and colleagues.[9] In the US, there was a national outbreak of EVALI, with 2807 hospitalizations and 68 deaths as of 18 February 2020.[47] This illness peaked in September 2019 and is now steadily declining.[48,49] In comparison, EVALI cases in Canada have been relatively sparse, with a total of 19 cases, 15 hospital admissions, and no deaths reported as of 11 March 2020.[50] EVALI was first reported in the US in August 2019 in a case series that included 53 patients.[51] Most of those patients presented with respiratory symptoms (dyspnea, cough, chest pain), gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain), and constitutional symptoms (fever, chills, malaise)

Based on toxicology data, consumer research, and public health modeling, though, the FDA gave a Modified Risk Tobacco Product (MRTP) order to 10 Zyn flavors at each of two strengths3 milligrams and 6 milligrams

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