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Redux (heart and lung problems)
Please complete this claim form to request a free case evaluation from a lawyer listed on BigClassAction.com.
Fields marked
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are required.
Defendant:
(who caused the harm?)
Redux (life threatening pulmonary hypertension)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Diet drug used: Redux?
Yes
No
Fen-Phen (aka Pondimin)?
Yes
No
Length of time used:
Pharmacy (name/city)
Heart Catheterization?
Yes
No
Dates:
Location:
Have you had an echocardiogram?
Yes
No
Have you been diagnosed with primary pulmonary hypertension?
Yes
No
Date of diagnosis:
Are you currently taking Flolan (Prostacyclin) or Tracleer?
Yes
No
If yes, how long?
Did you participate in the Class Action Settlement?
Yes
No
Color of Form: Pink?
Yes
No
Blue?
Yes
No
Orange?
Yes
No
Other:
*
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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