A previously fit 14-year old girl presented with a 3-day history of cough, chest discomfort, abdominal pain and rigors, following her first exposure to vaping 48 hours earlier. Her symptoms rapidly progressed and she required escalating amounts of respiratory support. Within 48-hours of presentation she was ventilated at high pressure and progressed to need oscillation and nitric oxide. She improved by day-8 of symptom onset and was breathing unassisted in air prior to discharge from intensive care.