COLUMBUS, Ohio (AP) — Health officials say they’re investigating 11 additional reports of Ohioans who vape who experienced severe breathing illnesses.

The Ohio Department of Health on Wednesday also said three previous illnesses under investigation were likely caused by vaping.

The agency said those three involved two women and a man from Lucas, Richland and Union counties. All required hospitalization.

The state has asked healthcare providers to report all suspected cases of serious pulmonary illness where the cause is unclear and the patients have a history of vaping, or using e-cigarettes. Symptoms have included coughing, shortness of breath, and fatigue.

Federal health officials said they are looking into more than 200 possible cases in 25 states.