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Vioxx Injuries
Contact us by phone at 1-800-283-2900  
 

If you, a friend or a family member has suffered from Vioxx, contact us by phone or complete the form below for a free consultation. As with any other claim, there is a mandatory time, otherwise known as a statute of limitations, in which the claim must be filed. Failure to file your claim immediately may undermine the validity of your case.
Personal Information
Title :
First Name : *
Middle Initial :
Last Name : *
Email Address : *
Home Phone :
Work Phone :
Street Address :
City :
State :
Zip Code :
Best way to Contact :
   
Injured Person Information
Date of Birth :
Inquiring on behalf of?
What is your relationship?
Person Deceased? Yes No
Cause of Death :
Date of Death :
Autopsy Performed? Yes No N/A
   
Case Information
During what period of time was Vioxx prescribed?
Start: End:
Why was Vioxx prescribed?
Dosage of Vioxx prescribed daily? (i.e. 25mg, 50mg, 75 mg) :
List names/addresses of any doctors who prescribed Vioxx :
List names/addresses of the pharmacies you purchased Vioxx from :
 
Did effects from Vioxx include?
Heart Attack: Yes No Stroke: Yes No
Blood Clots: Yes No Deep Vein Thrombosis: Yes No
Pulmonary Embolism: Yes No Death: Yes No
 
Other medical problems since Vioxx usage :
Case Description : *  
   
 
 
   
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