Raleigh, N.C. — A third North Carolina resident has been hospitalized with meningitis following a spinal injection with steroids linked to a multi-state outbreak, public health officials said Wednesday.

Twenty-eight people have died nationwide, including Elwina Shaw of Davidson County, and about 380 sickened by contaminated medication from a Massachusetts compounding pharmacy.

Three clinics in North Carolina received the tainted drugs from the New England Compounding Center in Framingham, Mass. Health officials said anyone who received a steroid injection from the clinics has been notified.

“We are urging providers to continue to be alert for symptoms of meningitis in patients that have received the contaminated medication,” State Health Director Dr. Laura Gerald said in a statement. “In this outbreak, symptoms typically have appeared within six weeks following injection, but it’s important to know symptoms could still appear months later.”