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One person has died and 10 have been hospitalised after an outbreak of E. coli linked to McDonald's Quarter Pounder burgers, the US Centers for Disease Control and Prevention (CDC) has said.
Infections were reported between 27 September and 11 October across 10 US states; Colorado, Iowa, Kansas, Missouri, Montana, Nebraska, Oregon, Utah, Wisconsin and Wyoming.
Colorado has 27 of the 49 reported cases - including an older person who died and one child who has severe kidney complications, the CDC said.
The public health agency said the number of illnesses is likely much higher and recent cases may not have been reported yet, as it usually takes three to four weeks to determine if a sick person is part of an outbreak.
It is unknown what ingredient is making people sick, but everyone interviewed in connection with the outbreak reported eating at McDonald's before falling ill - and most mentioned consuming the popular Quarter Pounder.
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McDonald's is working with public health officials to determine the contaminated ingredient, with investigators believed to be focusing on onions and beef.
The fast food restaurant chain told the CDC it had removed slivered onions and beef patties used for Quarter Pounders from stores in the affected states. The burgers may be temporarily unavailable in those areas.
E. coli is a group of bacteria found in the guts of animals. Infections can cause severe illness, including fever, stomach cramps, diarrhoea and vomiting.