Health officials have announced the first death linked to the Zika virus has occurred in Puerto Rico.

The U.S. Centers for Disease Control and Prevention reported Friday that a Puerto Rican man in his 70s died from internal bleeding related to a rare immune reaction to the Zika virus infection in late February.

The reaction, called immune thrombocytopenic purpura (ITP), has caused three deaths among people infected with Zika in Colombia, one death in Suriname and four deaths during French Polynesia’s 2013-2014 Zika outbreak, reports the Washington Post.

“Although Zika virus-associated deaths are rare, the first identified death in Puerto Rico highlights the possibility of severe cases, as well as the need for continued outreach to raise health care providers’ awareness of complications that might lead to severe disease or death,” the CDC said.