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washingtonpost.com/national/health-science/what-we-know-so-far-about-the-us-vaping-illness-outbreak/2019/09/10/146e4fbe-d40a-11e9-8924-1db7dac797fb_story.html Centers for Disease Control and Prevention

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Nicotine C-oxidation to nicotine 5(1)iminium ion is followed by a second oxidation that generates cotinine, which is further metabolized to trans 3-hydroxycotinine (3-HCOT), a reaction that is catalyzed almost exclusively by CYP2A6 (see Fig