In nine states, adverse reactions are caused by fake Botox, according to the FDA

The FDA said Tuesday that fake Botox caused 19 reports of vision problems, breathing problems, and swallowing issues in at least nine states.

Unlicensed products "may be misbranded, adulterated, counterfeit, contaminated, improperly stored and transported, ineffective and/or unsafe," the agency said on its website.

"The sources of these products are unverified and unknown, which is why this situation is certainly concerning," said CDC senior botulism epidemiologist Michelle Waltenburg. Waltenburg joins FDA and state health departments in the investigation.

Colorado, Florida, Illinois, Kentucky, Nebraska, New Jersey, New York, Tennessee, and Washington have cases.

Botox temporarily paralyzes muscles with purified botulinum toxin. It relaxes wrinkle-causing muscles when injected into specific facial areas.

A fake product could spread throughout the body, paralyzing breathing muscles.