In 40–50% of cases, bleeding from puncture sites and mucous membranes has been reported. In the bleeding phase, which typically starts 5 to 7 days after first symptoms internal and subcutaneous bleeding may present itself through reddening of the eyes and bloody vomit. Bleeding into the skin may create petechiae, purpura, ecchymoses and hematomas. Types of bleeding known to occur with Ebola virus disease include vomiting blood, coughing it up or blood in the stool. Heavy bleeding is rare and is usually confined to the gastrointestinal tract. In general, the development of bleeding symptoms often indicates a worse prognosis and this blood loss can result in death. All people infected show some symptoms of circulatory system involvement, including impaired blood clotting. If the infected person does not recover, death due to multiple organ dysfunction syndrome occurs within 7 to 16 days (usually between days 8 and 9) after first symptoms.