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Baxter Healthcare Corporation (infusion pumps causing death)

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Defendant:
(who caused the harm?)

Baxter Healthcare Corporation (Colleague Volumetric Infusion Pump Recall)

*Describe your complaint:
(briefly describe the damages you have suffered)

Did you or a loved one have a problem with an IV infusion pump while under a doctor's care in a legitimate medical facility?

Yes No

Did the IV pump fail?

Yes No

Could the IV pump have failed without your being notified at the time?

Yes No

If yes, why do you believe this?

Did the possible device malfunction result in injury, illness, or death?

Yes No

If an illness or injury occurred, did anyone relate the illness/injury to the pump failure officially?

Yes No

If yes, please explain:

If a fatality occurred, was an autopsy performed?

Yes No

If no autopsy was performed, what was the stated cause on the death certificate?

If an autopsy was performed, what was the corner's stated cause of death?

*First name:

*Last name:

*Email address:

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*Phone number(s):

*Zip/Postal Code:

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