Austin Adams, 17, was trying to quit smoking. So he turned to electronic cigarettes in an attempt to ease his addiction to tobacco.
He found the one he wanted — a device from a company called VGOD — and asked his mother, Kailani Burton, to buy it for him. She did. Adams had been using the new device when it exploded in his mouth. The force knocked out several teeth and shattered his jaw.
"Austin came in with his hand up to his mouth," Burton, 45, told NBC News. He was in shock and unable to speak.
Burton, who lives in rural Ely, Nevada with her family, had to drive her son five hours to the nearest hospital that could handle his injury: Primary Children's Hospital in Salt Lake City.
"This child had a blast injury to his lower jaw, as well as burns around his lip," said Dr. Katie Russell, one of the trauma surgeons who treated Adams.
Russell and a colleague described the case Wednesday in the New England Journal of Medicine.
Just last week, the FDA finalized guidance for manufacturers who are submitting new applications for tobacco products, which includes e-cigarettes. The agency now recommends that companies provide detailed information about the kinds of batteries they use, as well as plans for addressing the likelihood of overheating, fire and explosion.
E-cigarette explosions occur when the lithium-ion battery inside a vape pen overheats, according to the Food and Drug Administration. The FDA is in charge of regulating all tobacco products — including e-cigarettes.
But while the agency has sent warning letters to e-cigarette manufacturers about marketing violations and illegal sales to minors, they haven't issued any warning letters about the potential for the batteries to overheat and explode.
Instead, the FDA suggests that companies should rework their batteries to make them less likely to overheat.
"The FDA encourages manufacturers interested in making modifications to address battery safety issues to contact the agency to discuss options on how they can do so in a timely fashion and the FDA will consider each situation on a case-by-case basis," an FDA spokesman wrote in an email to NBC News.
The explosion which injured Adams was "totally unexpected," Russell told NBC News. "He didn’t recall doing anything wrong with the device beforehand, and it just exploded."
The incident, which occurred in March 2018, also tore a hole through the Adams's gums.
"The tissue kind of got vaporized," said Dr. Jonathan Skirko, a pediatric ear nose and throat surgeon who also treated the boy.
Skirko specializes in facial trauma, such as dog bites, a kick to the face from a horse, or injuries from ATV accidents. "I don't think I've seen an e-cigarette explosion like this, though," he told NBC News.
VGOD did not immediately respond to requests for comments.
"Flaming rockets"
Beyond the FDA, other federal agencies are taking notice.
A 2017 report from the U.S. Fire Administration, in charge of fire data collection, education, research and training, stated, "The shape and construction of electronic cigarettes can make them (more likely than other products with lithium-ion batteries) behave like 'flaming rockets' when a battery fails."
"It is clear that these batteries are not a safe source of energy for these devices," the report read.
For now, it's still up to consumers to fend for themselves. The FDA recommends making sure your e-cigarette has certain safety features, such as firing-button locks and holes for ventilation. The agency also discourages charging e-cigarettes overnight or allowing batteries to come into contact with coins, keys or other metal.
Two people in the U.S. are known to have died from e-cigarette explosions. A 24-year-old Texas man was killed in January when his e-cigarette exploded, sending a metal part of the vape pen into his neck, severing an artery. And last year, a Florida man died in a house fire authorities said started when an e-cigarette exploded.
Injuries related to vape pens, such as burns and explosions, may be more common than previously understood.
A study released last year uncovered 2,035 visits to U.S. emergency rooms from 2015 to 2017 for e-cigarette burns and explosion-related injuries.
That's nearly two visits a day over that three-year period.
"Some of the cases were very severe — people losing up to eight teeth, damage to the eyes, losing parts of their face or the roof of their mouth. A lot of third-degree burns," said lead author Matthew Rossheim, an assistant professor of global and community health at George Mason University.
Rossheim suggests the true number of injuries may be much higher, because his team only examined emergency room visits.
"It's an underestimate. We need better surveillance," he told NBC News.
The surgeons who treated Austin Adams in Utah needed to sew his gumline back together, then put plates on the jawbone itself to stabilize it. He also needed temporary braces to help his remaining teeth line up correctly. His jaw was wired shut for six weeks, which meant he could only have liquids and pureed food. He has since fully recovered from the injury.
The incident had one ironic benefit: He was able to quit smoking for good.
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