Home
Investigations
Lawsuits
Settlements
Legal News
FAQ
Blog
Home
> Request Legal Help
Request Legal Help
Guidant Defibrillator (defective defibrillator)
Please complete this claim form to request a free case evaluation from a lawyer listed on BigClassAction.com.
Fields marked
*
are required.
Defendant:
Guidant (Defective Defibrillator)
*
Describe Damages you Suffered:
Name of Implantee (if different):
Date of Birth:
Date of Death (if applicable):
Serial Number of unit (see ID Card):
Date of Implant:
Surgeon's Name:
Surgeon's Phone Number:
Was the device removed?
Yes
No
If yes, when?
If yes, where?
Where is the device now?
Which Guidant Cardiac Debfibrillator was Implanted?
Ventak Prizm AVT:
Yes
No
Prizm 2 DR:
Yes
No
Contak Renewal:
Yes
No
Contak Renewal 2:
Yes
No
Vitality AVT:
Yes
No
Renewal 3 AVT:
Yes
No
Renewal 4 AVT ICD:
Yes
No
Don't Know:
Yes
No
Other Debfibrillator:
Yes
No
If other, what is the name of defibrillator that was used?
What medical condition caused prompted the use of a defibrillator?
Additional comments:
*
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.
Receive our weekly newsletter by our sister publication LawyersandSettlements with the latest lawsuit news and legal information.
View last issue
By submitting this form I agree to the
Terms of Service
.
There is absolutely no cost to you to submit this form. Doing so places you under no obligations and does not establish an attorney-client relationship.
