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Serzone (liver damage)
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?)
Serzone (liver damage)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Has a doctor said that you have a medical condition caused by Serzone?
Yes
No
If yes, what was the diagnosis: Liver injury:
Yes
No
Liver failure:
Yes
No
Liver disease:
Yes
No
Other:
What was the date of the initial diagnosis:
What is your date of birth:
What dosage of Serzone was prescribed?
What side effects have you experienced? Jaundice (yellowing of skin and eyes:
Yes
No
Dark colored urine:
Yes
No
Loss of appetite:
Yes
No
Abdominal pain:
Yes
No
Physical discomfort and uneasiness:
Yes
No
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:
*
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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