LAWSUITS NEWS & LEGAL INFORMATION

Zelnorm (heart attack, stroke, death)

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Defendant:
(who caused the harm?)

Zelnorm (heart attack, stroke)

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

Have you or a loved one experienced Myocardial infarction?

Yes No

Have you or a loved one experienced Unstable angina?

Yes No

Have you or a loved one experienced Cardiac thrombus?

Yes No

Have you or a loved one experienced Resuscitated cardiac arrest?

Yes No

Have you or a loved one experienced Ischemic stroke?

Yes No

Have you or a loved one experienced Transient ischemic attacks?

Yes No

*Date of Birth: (mm dd yy)

*Date of incident:

*How long have you used Zelnorm?

Has a loved one experienced sudden or unexplained death?

Yes No

Do you have a copy of medical records?

Yes No

Can you get a copy of medical records?

Yes No

Were you or a loved one taking Zelnorm at the time the injury was suffered?

Yes No

If Zelnorm was not being taken at the time of the heart attack, stroke, etc.; how many days were there between the last day Zelnorm was taken and the heart attack, stroke, etc.?

State dates of Zelnorm use: from when (month, day, year) to when (month, day, year):

*First name:

*Last name:

*Email address:

*Confirm email address:

*Phone number(s):

*Zip/Postal Code:

Best time & way to contact you:

I would like to be interviewed by a journalist.

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