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Zelnorm (heart attack, stroke, death)
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?)
Zelnorm (heart attack, stroke)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Have you or a loved one experienced Myocardial infarction?
Yes
No
Have you or a loved one experienced Unstable angina?
Yes
No
Have you or a loved one experienced Cardiac thrombus?
Yes
No
Have you or a loved one experienced Resuscitated cardiac arrest?
Yes
No
Have you or a loved one experienced Ischemic stroke?
Yes
No
Have you or a loved one experienced Transient ischemic attacks?
Yes
No
*
Date of Birth: (mm dd yy)
*
Date of incident:
*
How long have you used Zelnorm?
Has a loved one experienced sudden or unexplained death?
Yes
No
Do you have a copy of medical records?
Yes
No
Can you get a copy of medical records?
Yes
No
Were you or a loved one taking Zelnorm at the time the injury was suffered?
Yes
No
If Zelnorm was not being taken at the time of the heart attack, stroke, etc.; how many days were there between the last day Zelnorm was taken and the heart attack, stroke, etc.?
State dates of Zelnorm use: from when (month, day, year) to when (month, day, year):
*
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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