Vioxx side effects - lawsuit

VIOXX
ATTENTION! VIOXX has been recalled. Merck the makers of Vioxx recalled their number one selling drug Vioxx due to serious and often fatal side effects such as stroke, heart attack, and blood clots.

Vioxx Case Evaluation

Required Items Marked With "*"
Name*:
Street Address*:
Apt. / Building Number:
City*:
State*:
Zip Code*:
E-Mail Address*:
Phone Number *:
 
Gender:
 Male Female
Date of Birth :
How Many MG's Was Your Prescription For?:
How Many Times Per Day Did You Take Vioxx?:
When Did You Start Taking Vioxx?:
When Did You Stop Taking Vioxx?:
What Side Effects Have You Experienced?:
Where Any Of The Side Effects Experienced Before Taking Vioxx?:
Yes No
Whom Are You Inquiring On Behalf Of?
Is The Person Deceased?:
 Yes No
If Deceased What Was The Cause Of Death as Listed on The Death Certificate?
List The Names Of Any Doctors Who Prescribed Vioxx:
Why Was Vioxx Prescribed?:
   
Where There Any Medications Taken With Vioxx?:
Yes No
If So Please List Them Here:
Have You Developed Any Serious Medical Conditions Since Taking Vioxx?:
Yes No
If So Please List Them Here:
When Were You Diagnosed?*:
Is There A Family History of Heart Attack or Stroke?*:
Yes No
How Did You Hear About Us?*:
If You Found Us Through A Search Engine Which One Did You Use?:
Additional Comments: