The FDA, along with the CDC and the Southern Nevada Health District, investigated a number of reports of acute non-viral hepatitis associated with “Real Water” brand alkaline water. A total of 25 cases (21 probable, 4 suspect) were reported from California (3 probable) and Nevada (18 probable, 4 suspect). Most cases occurred in November 2020. Twenty three cases were hospitalized. There was one death.

FDA collected consumer and non-consumer alkaline/non-alkaline water, chemicals, and concentrates. Laboratory analyses did not identify the contaminant that could have led to the illnesses. On June 1, 2021, FDA announced that Real Water Inc. agreed to cease operations until they could comply with the Federal Food, Drug, and Cosmetic Act (FD&C Act) and other requirements listed in a consent decree.