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Taxus Stents (death or stroke)
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?)
Taxus Stents (death or stroke)
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Describe your complaint:
(briefly describe the damages you have suffered)
What is the best way to contact you? (time, phone number, etc.
Additional contact infomation:
Date of Birth: (mm dd yy)
Whom are you inquiring on behalf of? (self, minor, other)
If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased?
Yes
No
If deceased, what is the cause of death as stated on the death certificate?
Date of death:
Was there an autopsy performed?
Yes
No
Date surgery occured: (mm dd yy)
Name, city and state of the hospital where the surgery was performed:
Name and address of Doctor who performed surgery:
What condition required surgery to be performed?
Do you know that the Taxus stent was used in your surgery?
Yes
No
Did the Taxus stent cause any of the following: Death
Yes
No
Blood clots
Yes
No
Allergic reactions
Yes
No
Additional surgery
Yes
No
Other:
Please describe injury caused by defective Taxus stent:
Do you have a copy of your medical records?
Yes
No
Can you get a copy of your medical records?
Yes
No
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First name:
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Last name:
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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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