A listeria outbreak linked to frozen nutritional milkshakes is to blame for 12 deaths and dozens of hospitalizations, the U.S. Food and Drug Administration confirmed Monday following an investigation that spanned years.

The frozen shakes were served at hospitals and long-term care facilities, sickening 38 people and resulting in 11 deaths in 21 states, according to the FDA.

Twelve deaths have been reported as part of an outbreak of Listeria monocytogenes infections linked to frozen supplemental shakes, the US Food and Drug Administration said Monday. At least 38 people in 21 states had been infected,