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Legal buyers not manufacturers and retailers are the primary source for tobacco products used by underage high schoolers (here)

How is EVALI diagnosed

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Despite its rare incidence, the hematogenous dissemination of the bacilli is possible, and some conditions like immunosuppression, disruption of the urothelial barrier due to traumatic catheterization, concurrent urinary tract infection or early instillation after transurethral resection may promote it.3 The disseminated BCG infection is a different condition from the flu-like symptoms post-instillation and the local complications in the genitourinary tract that can appear during treatment

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