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Bextra (Stevens Johnson Syndrome)
Please complete this claim form to request a free case evaluation from a lawyer listed on BigClassAction.com.
Fields marked
*
are required.
Defendant:
(who caused the harm?)
Bextra (skin inflammation SJS)
*
Describe your complaint:
(briefly describe the damages you have suffered)
When did you start taking Bextra?
How long have you taken Bextra?
Do you still have any Bextra?
Yes
No
Which other medications have you taken while taking Bextra?
Have you developed SJS?
Yes
No
Have you developed TEM?
Yes
No
Have you developed EM?
Yes
No
If yes, where were you treated?
How long was your hospital stay?
Approx. amount of hospital bills:
Description of injury or death:
*
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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