An Arizona woman has died after eating salmonella-tainted cucumbers grown in Mexico, marking the third fatality from the widespread outbreak, health officials said on Friday.

The woman in her late 50s, who suffered from serious underlying health problems, died on Sept. 4 at a Tucson, Arizona-area hospital, said Pima County Health Department spokesman Aaron Pacheco.

Federal health officials have confirmed deaths in Texas and California from the strain of Salmonella Poona, and another 91 people have been hospitalized.

The outbreak has made 418 people ill across 31 states, with 52 percent of those infected being younger than 18, according to the U.S. Centers for Disease Control and Prevention (CDC).

The agency said the outbreak was caused by tainted cucumbers produced in Baja California, Mexico, and distributed by Andrew and Williamson Fresh Produce in San Diego. Company officials said they have voluntarily recalled all of its Limited Edition brand label cucumbers sold between Aug. 1 and Sept. 3.

About 1.2 million people annually become ill from salmonella, with about 450 cases resulting in death, the CDC reports. Symptoms may include headache, stomach pain, diarrhea, nausea and sometimes vomiting within 72 hours of ingesting a contaminated food or drink, Arizona health officials said.

Consumers who purchased the recalled cucumbers are advised not to eat them. According to the CDC, consumers, restaurants and retailers who aren’t sure if their cucumbers were recalled should not eat, sell or serve them.

The Food and Drug Administration (FDA) advises consumers to first wash their hands for at least 20 seconds with soap and water before and after preparing any fresh produce. Fresh produce should be washed thoroughly under running water before they are eaten, cut or cooked.

Reuters contributed to this report.