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ACE Inhibitors (birth defects)
Please complete this claim form to request a free case evaluation from a lawyer listed on LawyersAndSettlements.com.
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Defendant:
(who caused the harm?)
ACE Inhibitors (birth defects)
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Describe your complaint:
(briefly describe the damages you have suffered)
Did you take an ACE Inhibitor during pregnancy?
Yes
No
What drug did you take?
Did your doctor advise you to discontinue use during your pregnancy?
Yes
No
Did you take the drug throughout your entire pregnancy?
Yes
No
If not, which trimester or trimesters did you take the drug?
How long had you been taking the drug?
Are you still taking the drug?
Yes
No
What was the date of birth of your child?
Was your child born with a birth defect after or while using the ACE Inhibitor?
Yes
No
What type of birth defect was your child born with?
Were you advised of other factors that may have caused your child's birth defect?
Yes
No
If yes, what were those causes?
Have you lost a child due to complications linked to any of these birth defects?
Yes
No
Do you have a copy of medical records?
Yes
No
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First name:
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Last name:
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Email address:
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Confirm email address:
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Phone number(s):
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Zip/Postal Code:
Best time & way to contact you:
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