E-Cigarettes and Seizures, Bronchiolitis Obliterans Organizing Pneumonia, and Hemorrhagic Strokes

Fueled by misleading safety claims, aggressive marketing, youth-tempting flavors, and one of the most addictive substances known to humans, e-cigarettes have hooked a new generation of young people on nicotine. But vaping can pose serious risks to users, including seizures, strokes, respiratory illness, and even death. Manufacturers should pay for the harm their e-cigarettes cause.
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FDA Reports Potential Risk of Seizures

In April of 2019, the U.S. Food and Drug Administration (FDA) released a statement notifying the public about reports of seizures occurring after e-cigarette use, particularly among young adult users. (1)

The FDA identified 35 cases of seizures in e-cigarette users reported to the FDA and poison control centers over nine years. (2) The agency believes these cases “warrant scientific investigation into whether there is in fact a connection.” (3) Most of the reports involved youth and young adults. (4)

The agency also noted that because reporting is voluntary, other instances may have gone unreported. The FDA statement urges healthcare providers and consumers to become aware of vaping and seizures, and to report any adverse experiences to the Safety Reporting Portal (SRP). (5)

Vape pen

What Is an E-Cigarette?

Electronic cigarettes, also known as e-cigarettes or e-cigs, are handheld devices that produce “vapors” for users to inhale. The vapors are formed by heating a liquid that typically contains nicotine, artificial flavorings, and other chemicals. (6) (7)

Initially designed to simulate the experience of smoking a cigarette, “vaping” is now a popular habit among people, especially adolescents, who have never been smokers. (8) (9) Some e-cigarettes resemble tobacco products such as cigarettes and cigars, while other designs look more like pens or USB sticks.

Common nicknames for e-cigarettes include:

  • E-cigs.
  • Vapes.
  • Vape pens.
  • Vaporizers.
  • Electronic nicotine delivery systems (ENDS).

Popular e-cigarette brands include:

  • JUUL.
  • blu.
  • Logic.
  • MarkTen.
  • Vuse.

The liquid in e-cigarettes, known as “e-liquid” or “e-juice,” is typically sold in cartridges or “pods.” The ingredients and composition of e-liquid varies greatly across brands. There are more than 7,000 different flavors available on the market. (10) Nicotine concentrations and additives vary widely across products. (11) (12) (13)

Nicotine is extremely addictive. Some e-cigarette products deliver higher doses of nicotine than traditional cigarettes. Many of the other chemicals found in e-liquid are unstudied, and the long-term health consequences of vaping are unknown. (14)

Vaping Industry Under Fire for Aggressively Marketing to Youth

E-cigarettes are increasingly popular with children and young adults. In 2018, one in five high school students and one in twenty middle school students used e-cigarettes. (15)

The most popular brand of e-cigarette is JUUL, which accounted for 70% of the e-cigarette market share in 2019. (16) The JUUL is a device shaped like a USB flash drive and charge using a USB port. “JUULpods” come in flavors like “mango” and “creme.”

E-cigarette companies claim their products are intended as a safer alternative to cigarettes for people who already smoke. But the industry uses marketing tactics that seemingly target adolescents, even though very few are smokers. Aggressive social media campaigns, music festivals sponsorships, candy- or other food-like flavors, and youth-oriented packaging have lured millions of youth into tobacco addiction. (17) (18)

In May of 2018, the FDA sent official requests to JUUL and three other e-cigarette manufacturers “requiring them to submit important documents to better understand the youth appeal of these products.” According to FDA Commissioner Scott Gottlieb, the agency is “taking a hard look at whether certain design features and product marketing practices are fueling the youth use” of e-cigarettes. (19) In response, some e-cigarette manufacturers produced a plan to curb underage vaping. But in early 2019, the FDA accused e-cigarette manufacturers of backtracking on their promises “to restrict their products in a way that will decrease access to kids.” (20)

Teen girl vaping

Dangers Among Children and Young Adults

There are many dangers inherent to vaping among youth and young adults. E-cigarette use has been found to predict the use of combustible cigarettes and other tobacco products. Adolescents who had “no intention of smoking” when they start vaping were found to be more likely to become combustible cigarette smokers than adolescents who have never used e-cigarettes. (21)

Nicotine exposure can harm adolescent brain development, affecting attention, memory, and cognition. (22) Using nicotine products may “prime the adolescent brain for addiction to other drugs.” (23)

Beyond nicotine, the flavorings found in e-cigarettes, which significantly contribute to their popularity with youth, are another source of health risks. (24) According to the Surgeon General, “Some chemicals in e-cigarettes, although approved for ingestion, have established adverse health effects when inhaled.” (25) For example, chemicals used to produce vanilla, cinnamon, and chocolate flavors have demonstrated cellular toxicity. (26) (27) (28) Also, mixing flavors together, as young people often do in social settings, may increase toxicity. (29)

The relationship between vaping and seizures is another cause for concern for young e-cigarette users. Developing brains are more susceptible to seizures than adult brains. (30)

E-Cigarettes and Bronchiolitis Obliterans Organizing Pneumonia

Bronchiolitis obliterans organizing pneumonia (BOOP), also often referred to as cryptogenic organizing pneumonia (COP), is a rare lung disease characterized by inflammation that manifests as swirls of fibrous tissue filling the bronchioles and alveoli in the lungs. (31) (32) There are at least two published case studies of e-cigarette users developing BOOP, both of which required hospitalization, intubation, and mechanical ventilation. (33) (34)

E-Cigarettes and Hemorrhagic Strokes

Additional support for the link between e-cigarettes and strokes is provided by a 2017 study on the pulmonary effects of e-cigarettes. The study examined healthy young adults after 30 minutes of vaping and found “a significant increase in heart rate and blood pressure in the volunteers who were exposed to e-cigarettes containing nicotine.”(35) High blood pressure is a significant risk factor for strokes. (36)

“A significant increase in heart rate and blood pressure in the volunteers who were exposed to e-cigarettes containing nicotine.”

Symptoms of Seizures

Symptoms of different types of seizures may include:

  • Muscle spasms.
  • Loss of consciousness or awareness.
  • Uncontrollable jerking of your limbs.
  • Perceptual disturbances.
  • Confusion.
  • Staring spells.
  • Body stiffening and shaking.
  • Loss of bladder or bowel control. (37)

Several of the seizures described in the incident reports released by the FDA describe grand mal or tonic-clonic seizures, (38) characterized by the dramatic convulsions people often associate with seizures. But there are many types of seizures, and some have subtler, more mild symptoms. (39) Mild seizures are probably less likely to be reported.

Symptoms of Bronchiolitis Obliterans Organizing Pneumonia

Patients suffering from bronchiolitis obliterans organizing pneumonia may experience a flu-like illness, cough, shortness of breath, severe respiratory distress, and crackling or rattling sounds in the lungs (known as crackles or rales, respectively). Diagnosis of bronchiolitis obliterans organizing pneumonia is usually confirmed by evaluation of clinical symptoms, a chest x-ray or high-resolution chest computed tomography (CT), and a lung biopsy. (40)

Symptoms of Hemorrhagic Strokes

The National Stroke Association recommends the acronym FAST to identify the warning signs of a stroke: (41)

  • Face: does one side of your face droop when smiling?
  • Arms: when you raise your arms, does one arm drift down?
  • Speech: is speech slurred or odd?
  • Time: is of the essence. Call 911 immediately if you witness or experience any of these symptoms.

Additional symptoms of hemorrhagic strokes include: (42)

  • Sudden severe headache.
  • Sudden numbness or weakness in face or limb, especially on one side of the body.
  • Sudden confusion or trouble speaking.
  • Sudden vision problems, in one or both eyes.
  • Sudden loss of balance or coordination, dizziness, or trouble walking.

Potential Lawsuit Claims

Young people have been lured into a highly addictive habit without being informed of the risks. Many youth vape just for the flavor. They are unaware they are inhaling a dangerous drug. According to the Surgeon General, “It is questionable whether youth know what nicotine is, let alone whether it is contained in the e-cigarette products that they are using.” (43)

Suffered Seizures or Strokes after using E-Cigarettes? Speak to an experienced attorney today for a free consultation.

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Even e-cigarette users who are aware of the risks of nicotine may be coaxed into a false sense of safety. Featuring high-tech designs and free of messy smoke, vapes seemingly offer precise control over what goes into your body.

But e-liquid labels often state an inaccurate nicotine content. A study of e-liquids for sale in North Dakota vape stores found more than half the products sampled listed nicotine concentrations that were off by 10% or more. One sample contained “172% more than the labeled quantity.” (44)

Young people harmed by vaping products may be entitled to compensation. Weitz & Luxenberg is currently taking cases on behalf of children and young adults under the age of 25 who experienced:

  • Seizure.
  • Hemorrhagic stroke (intracerebral hemorrhage).
  • Bronchiolitis obliterans organizing pneumonia (also called cryptogenic organizing pneumonia).
  • Death due to any of these.

W&L’s attorneys have decades of experience helping people harmed by dangerous products obtain justice from the corporations responsible for their injuries. Some of our recent successes include billions of dollars in settlement funds for dangerous metal-on-metal hip implants and a $9 billion jury verdict for a client who developed cancer after taking the drug Actos.*

*Past performance is no guarantee of future results. The Actos verdict was reduced to approximately $38 million by the trial court on October 27, 2014. The settlements in which Weitz & Luxenberg played leadership roles included patients not represented by W&L.

  1. U.S. Food & Drug Administration. (2019, April 3). Statement from FDA Commissioner Scott Gottlieb, M.D., and Principal Deputy Commissioner Amy Abernethy, M.D., Ph.D., on FDA’s ongoing scientific investigation of potential safety issue related to seizures reported following e-cigarette use, particularly in youth and young adults. Retrieved from https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-principal-deputy-commissioner-amy-abernethy-md-phd
  2. Ibid.
  3. Ibid.
  4. U.S. Food & Drug Administration. (2019, April 10). Some E-cigarette Users Are Having Seizures, Most Reports Involving Youth and Young Adults. Retrieved from https://www.fda.gov/tobacco-products/ctp-newsroom/some-e-cigarette-users-are-having-seizures-most-reports-involving-youth-and-young-adults
  5. Ibid.
  6. U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. 3. Retrieved from https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf
  7. U.S. Food & Drug Administration. (n.d.) Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS). Retrieved from https://www.fda.gov/tobacco-products/products-ingredients-components/vaporizers-e-cigarettes-and-other-electronic-nicotine-delivery-systems-ends
  8. U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. 28-57. Retrieved from https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf
  9. Centers for Disease Control and Prevention. (2019, February 11). Progress Erased: Youth Tobacco Use Increased During 2017-2018. Retrieved from https://www.cdc.gov/media/releases/2019/p0211-youth-tobacco-use-increased.html
  10. Zhu, S-H. et al., (2014, June 16). Four hundred and sixty brands of e-cigarettes and counting: implications for product regulation. Retrieved from https://tobaccocontrol.bmj.com/content/tobaccocontrol/23/suppl_3/iii3.full.pdf
  11. Buettner-Schmidt, K., et al. (2016, April 12). Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors. Journal of Pediatric Nursing. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914438
  12. Hahn, J. et al., (2014, December 9). Electronic cigarettes: overview of chemical composition and exposure estimation. Tobacco Induced Diseases. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304610
  13. Farsalinos, K.E., et al. (2014, September 1). Evaluation of Electronic Cigarette Liquids and Aerosol for the Presence of Selected Inhalation Toxins. Nicotine & Tobacco Research, 2015, 168–174. Retrieved from https://academic.oup.com/ntr/article-abstract/17/2/168/2858003.
  14. Kaur, G, et al., (2018, February 28). Immunological and toxicological risk assessment of e-cigarettes. European Respiratory Review. Retrieved from https://err.ersjournals.com/content/27/147/170119
  15. Cullen, K., et al. (2018, November 16). Notes from the Field: Use of Electronic Cigarettes and Any Tobacco Product Among Middle and High School Students — United States, 2011–2018. Morbidity and Mortality Weekly Report, 67, 1276–1277. Retrieved from https://www.cdc.gov/mmwr/volumes/67/wr/mm6745a5.htm
  16. Bach, L. (2019, March 19). JUUL and Youth: Rising E-Cigarette Popularity. Campaign for Tobacco-Free Kids. Retrieved from https://www.tobaccofreekids.org/us-resources/fact-sheet/juul-and-youth-rising-e-cigarette-popularity
  17. U.S. Food & Drug Administration. (n.d.) E-Liquids Misleadingly Labeled or Advertised as Food Products. Retrieved from https://www.fda.gov/tobacco-products/ctp-newsroom/e-liquids-misleadingly-labeled-or-advertised-food-products
  18. U.S. Food & Drug Administration. (2018, September 18) FDA launches new, comprehensive campaign to warn kids about the dangers of e-cigarette use as part of agency’s Youth Tobacco Prevention Plan, amid evidence of sharply rising use among kids. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-launches-new-comprehensive-campaign-warn-kids-about-dangers-e-cigarette-use-part-agencys-youth
  19. U.S. Food & Drug Administration. (2018, May 17). FDA requires additional e-cigarette makers to provide critical information so the agency can better examine youth use and product appeal, amid continued concerns around youth access to products. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-requires-additional-e-cigarette-makers-provide-critical-information-so-agency-can-better-examine
  20. Kaplan, S. (2019, January 4). F.D.A. Accuses Juul and Altria of Backing Off Plan to Stop Youth Vaping. The New York Times. Retrieved from https://www.nytimes.com/2019/01/04/health/fda-juul-altria-youth-vaping.html
  21. Barrington-Trimis, J.L., et al. (2016, July). E-Cigarettes and Future Cigarette Use. Pediatrics, 138:1. Retrieved from https://pediatrics.aappublications.org/content/138/1/e20160379
  22. U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. 104-6. Retrieved from https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf
  23. U.S. Department of Health and Human Services. (n.d.) Know the Risks: E-cigarettes & Young People. Retrieved from https://e-cigarettes.surgeongeneral.gov/knowtherisks.html
  24. Harrell, M. B., et al. (2017, April). Flavored Tobacco Product Use among Youth and Young Adults: What if Flavors Didn't Exist? Tobacco regulatory science, 3(2), 168–173. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5536860
  25. U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. 116. Retrieved from https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf
  26. Sassano, M. F., et al. (2018, March 27). Evaluation of e-liquid toxicity using an open-source high-throughput screening assay. PLoS biology, 16(3), e2003904. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870948
  27. Sherwood, C. & Boitano, S. (2016, May 17). Airway epithelial cell exposure to distinct e-cigarette liquid flavorings reveals toxicity thresholds and activation of CFTR by the chocolate flavoring 2,5-dimethypyrazine. Respiratory Research, 17:57. Retrieved from https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-016-0369-9
  28. Muthumalage, T., et al. (2018, January 11). Inflammatory and Oxidative Responses Induced by Exposure to Commonly Used e-Cigarette Flavoring Chemicals and Flavored e-Liquids without Nicotine. Frontiers in physiology, 8, 1130. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768608
  29. Ibid.
  30. Velísková J., et al. (2004) Seizures in the developing brain. Epilepsia, 45 Suppl 8:6-12. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15610187
  31. Epler, G.R. (2001, January 22). Bronchiolitis Obliterans Organizing Pneumonia. Arch Intern Med, 161(2), 158–164. Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/647172
  32. National Organization for Rare Disorders. (2018). Rare Disease Database. Bronchiolitis Obliterans Organizing Pneumonia. Retrieved from https://rarediseases.org/rare-diseases/bronchiolitis-obliterans-organizing-pneumonia/
  33. Mantilla, R.D., et al. (2016, May 7). Vapor Lung: Bronchiolitis Obliterans Organizing Pneumonia (BOOP) in Patient with E-Cigarette Use. D22. Reducing Harms of Tobacco Use. American Journal of Respiratory and Critical Care Medicine. Retrieved from https://www.atsjournals.org/doi/abs/10.1164/ajrccm-conference.2016.193.1_MeetingAbstracts.A6513
  34. Khan, M.S., et al. (2018, February 2). Organizing pneumonia related to electronic cigarette use: A case report and review of literature. The Clinical Respiratory Journal, 12:3, 1295– 1299. Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/crj.12775
  35. European Lung Foundation. (2017, September 10). E-cigarettes linked to increased arterial stiffness, blood pressure and heart rate in humans. ScienceDaily. Retrieved from www.sciencedaily.com/releases/2017/09/170910232512.htm
  36. American Heart Association. (2016, October 31). How High Blood Pressure Can Lead to Stroke. Retrieved from https://www.heart.org/en/health-topics/high-blood-pressure/health-threats-from-high-blood-pressure/how-high-blood-pressure-can-lead-to-stroke
  37. WebMd. (2017, July 12).Types of Seizures and Their Symptoms. Retrieved from https://www.webmd.com/epilepsy/types-of-seizures-their-symptoms#1
  38. Anonymous. Tobacco Product Report. (n.d.). Safety Reporting Portal Redacted Reports of Past Incidents. Retrieved from https://www.fda.gov/media/122794/download
  39. U.S. National Library of Medicine. (2018, October 23). Seizures. Medline Plus. Retrieved from https://medlineplus.gov/seizures.html
  40. National Organization for Rare Disorders. (2018). Rare Disease Database. Bronchiolitis Obliterans Organizing Pneumonia. Retrieved from https://rarediseases.org/rare-diseases/bronchiolitis-obliterans-organizing-pneumonia/
  41. National Stroke Association. (n.d.). Act FAST. Retrieved from https://www.stroke.org/understand-stroke/recognizing-stroke/act-fast
  42. National Stroke Association. (n.d.). Additional Symptoms of Stroke. Retrieved from https://www.stroke.org/understand-stroke/recognizing-stroke/signs-and-symptoms-of-stroke
  43. U.S. Department of Health and Human Services. (2016). E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. 116. Retrieved from https://e-cigarettes.surgeongeneral.gov/documents/2016_sgr_full_report_non-508.pdf
  44. Buettner-Schmidt, K., et al. (2016, April 12). Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors. Journal of Pediatric Nursing. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4914438

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