A second patient has died in Michigan from what officials are calling a vaping-related lung injury.

The Michigan Department of Health and Human Services says the man died on Tuesday.

The state is reporting 56 confirmed and probable vaping-related lung injury cases since August, and the CDC says that number is now nearly 2300 in 49 states. Forty-seven people have died in 25 states, not counting Tuesday’s death in Michigan.

Health officials say the patients have reported vaping THC and nicotine.