Adele’s on-again-off-again tour is now off again. The British singer has canceled her sold-out, 10-stop tour of the U.S. due to a vocal chord hemorrhage.

Having struggled with vocal chord issues before (she recently canceled and later rescheduled six dates due to laryngitis), Adele was wrapping up the U.K. leg of her tour and preparing to launch her U.S. tour on Oct. 7 in Atlantic City, N.J. when doctors told her that she needed an extended rest period in order to recuperate.

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