Federal regulators are cautioning U.S. consumers against drinking “Real Water,” a Las Vegas-based product that is still sold online and promoted on social media despite being recalled due to an outbreak of liver illness that has hospitalized five children. 

The warning from the U.S. Food and Drug Administration comes as the agency, along with the Centers for Disease Control and Prevention and the Southern Nevada Health District, investigate reports of acute non-viral hepatitis in Nevada linked to the brand of alkaline water. 

“The FDA has become aware that ‘Real Water’ brand alkaline water is still being offered for sale through online retailers,” the regulatory agency stated on Wednesday. In assessing the effectiveness of the company’s voluntary recall last month, the FDA also found a number of distributors had not been notified by the company of the recall. 

“[A]s of March 31, 2021, Real Water Inc. is still promoting the product via social media despite issuing a recall announcement,” the agency stated. “Therefore, the FDA is reiterating that it is crucial that consumers, restaurants, distributors, and retailers not drink, cook with, sell or serve ‘Real Water’ alkaline water.”

The agency also advised against giving the water to pets. 

Five children were hospitalized in late 2020 in Clark County, but have since recovered, according to a report by the Las Vegas-based Southern Nevada Health District, which first received initial reports of the five cases in November 2020. Although the cause of those illnesses is uncertain, the health officials pointed to the water brand as a possible link in all the cases.

“The patients lived in four different households. Six additional people have reported experiencing less severe symptoms that include vomiting, nausea, loss of appetite and fatigue. These patients include three adults and three children,” the health district added.

The FDA said the company, with facilities in Henderson, Nevada, and Mesa, Arizona, was not cooperating with the outbreak investigation. 

The recalled products include 5-gallon and 3-gallon containers of Real Water sold through home delivery/subscription, bottles of various sizes sold online and in stores, as well as concentrate sold online. The firm’s press release also includes 1.5 liter, 1 liter, 500 ml, and 1-gallon ready-to-drink alkaline water bottles and the 4 oz. concentrate.

The recalled products are available nationwide, according to the company’s press release, but the 5-gallon containers were distributed in Nevada, California and Arizona.

Symptoms of all types of hepatitis, including non-viral hepatitis, can include fever, fatigue, loss of appetite, nausea, vomiting, abdominal pain, dark urine, clay or gray-colored bowel movements, joint pain, yellow eyes and jaundice. 

Real Water is marketed in boxy blue plastic bottles as mineral-rich and “alkalized” and “infused with negative ions.”