Have you or a loved

one suffered serious

side effects from

the use of VIOXX?

CLICK HERE

VIOXX FAQ'S
 

FILING A VIOXX LAWSUIT

 

Find out if you have a claim against Merck & Co., Inc. (makers of Vioxx)

 

Personal Information
 
First Name
Last Name
Street Address
City
State
Zip Code
Home Phone
Cell Phone
Email

 

 


Claim Information
 
For whom are you submitting this information? Self  Family Member
If for family member, please provide name:
Age
Relationship

Vioxx Use
 
Date you began taking Vioxx
Date you stopped taking Vioxx

While you were taking Vioxx, did you suffer from any of the following conditions:
 
Heart Attack Yes  No
Stroke Yes  No
Blood Clots Yes  No
Deep Vein Thrombosis Yes  No
Pulmonary Embolism Yes  No
If submitting for a family member, Death Yes  No
   

Please list the dates of any of the above

conditions and describe the extent of

your injuries resulting from your use of Vioxx.
 
Are you presently covered by health insurance? Yes  No
Have you previously retained an attorney to represent you in this matter? Yes  No
   
 

 

 

 

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