LAWSUITS NEWS & LEGAL INFORMATION

Cypher Coronary Stents (blood clots)

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Defendant:
(who caused the harm?)

Cypher Coronary Stents© (blood clots)

*Describe the nature of your complaint in one short sentence:

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Additional contact information:

Date of Birth: (mm dd yy)

Whom are you inquiring on behalf of? (self, minor, other)

If you are NOT inquiring on your own behalf, what is your relationship?

Is the person deceased?

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If deceased, what is the cause of death as stated on the death certificate?

Date of Death:

Was there an autopsy performed?

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Date surgery occurred: (mm dd yy)

Name, city, and state of the hospital where the surgery was performed:

Name and address of Doctor who performed surgery:

What condition required surgery to be performed?

Do you know that the Cypher Stent was used in your surgery?

Yes No

Did the Cypher Stent cause any of the following? Death

Yes No

Blood Clots

Yes No

Allergic Reactions

Yes No

Additional Surgery

Yes No

Other

Yes No

Please describe injury caused by defective Cyber Stent:

Do you have a copy of your medical records?

Yes No

Can you get a copy of your medical records?

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