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Free Case Evaluation

DRUG INJURY CASE EVALUATION

Our law firm represents people in personal injury and wrongful death cases that involve serious side effects or serious reactions caused by an unsafe drug or recalled drug, as well as adverse drug events and adverse drug reactions resulting from a drug-drug interaction or a medication error.

The information you provide to us for this Free Case Evaluation will be treated as strictly confidential.  You will get a reply from us no later than the next business day.  Submitting a case evaluation does not obligate you to hire our law firm for your lawsuit.  We handle all cases on a contingency fee basis, which means that you will make no payment for our legal services until after we have succeeded in getting legal compensation for you.

If you need immediate advice or legal representation for a possible claim, call us on our toll-free number: (800) 426-9535.

Please do not hesitate to contact us, as there are no legal fees or any other costs incurred whether you fill out our case evaluation form or call our office to speak about a possible case.

Personal Information

*Required Fields

*Your Name:

*E-mail:

Street Address:

City:

State:

Zip:

*Phone Number:

Best time to call: DayNight

Case Facts

1. Have you, a family member, or some other person you know suffered a serious side effect while taking one or more prescription drugs? YesNo

If yes, please indicate which condition(s) or disease(s) the doctor diagnosed; check all that apply:

Bladder Cancer
Birth Defect
Serious Bleeding
Hemorrhages
Liver Failure
Liver Injury
Liver Disease
Drug-Induced Hepatitis
Acute Renal Failure
Kidney Failure
Kidney Injury
Pancreatitis
Tendon Rupture / Tear
Rhabdomyolysis
Pulmonary Embolism (PE)
Deep Vein Thrombosis (DVT)
Stroke (Cardiovascular Accident or CVA)
Cardiopulmonary Arrest (CPA) or Cardiac Arrest
Sudden Cardiac Death
Heart Attack or Myocardial Infarction (MI)
Acute Coronary Syndrome (ACS)
Heart Failure
Heart Valve Damage
Stevens-Johnson Syndrome (SJS)
Toxic Epidermal Necrolysis (TEN)
Hypersensitivity Reaction (such as Anaphylaxis)
Organ Transplant
Other

2. Would the case you are describing be a personal injury case or a wrongful death case:
Wrongful DeathPersonal Injury

3. Is this for you or someone else, and if it is for someone else, what is her relationship to you?
MeSomeone Else
Relationship:

4. What was the date of the initial diagnosis:

5. What is your date of birth of the person who had the side effect:

6. Has a lawsuit been filed concerning the side effect? YesNo

7. Please list below the prescription drug(s) that are suspected to have caused the side effect:

Please enter any additional information about this claim, as well as any comments or questions you may have, in the following space:

  • US FDA advises that you should not stop taking any prescription medication before talking to your doctor.
  • Reports of serious drug side effects should be made to the US FDA MedWatch program.
  • The prescription drug names are registered trademarks of the respective drug companies.
  • DrugInjuryLaw.com is not affiliated with any of the drug companies, nor US FDA.