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Baycol (side effects)
Please complete this claim form to request a free case evaluation from a lawyer listed on BigClassAction.com.
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Defendant:
(who caused the harm?)
Baycol (Rhabdomyolysis)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Have you taken Baycol?
Yes
No
Have you taken Lopid?
Yes
No
In which state was the drug prescribed?
Date you started taking the drug:
Date you stopped taking the drug:
Have you experienced Rhabdomyolsis?
Yes
No
Have you experienced Muscualar Pain?
Yes
No
Have you experienced Kidney Failure or problems?
Yes
No
Please state your inquiry:
Do you have a copy of your medical records?
Yes
No
Can you get a copy of your medical records?
Yes
No
*
First name:
*
Last name:
*
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:
I would like to be interviewed by a journalist.
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