Paxil Side Effects

Paxil Suicide Lawsuits Submission

To have a lawyer review your concern, fill out the information and write a brief description of your paxil related injury in the form below. This information will be kept private and confidential and used for the sole purpose of evaluating your case. Please note that without a phone number or e-mail address we will not be able to contact you. Attorneys serve all 50 states. Please read our disclaimer and terms of use. You are not entering into an attorney client relationship. Read on >>


Title:

* First Name:

  M. I.

 

* Last Name:

 Address:

 City:

 State:

 Zip Code:

* Phone Number (day)
(Required for a response):

 Phone Number (eve):

* Email Address 

 If this inquiry is not for yourself, please tell us the name of the person?:

Title:

First Name:

M. I.

Last Name:

What is the Injured's relationship to you?:

 Injured's Date of Birth?
(ie mm/dd/19yy) 

 

 Have you or they taken Paxil?:

Yes No

When was the medication first prescribed?:

 Why was the medication prescribed?:

Did you or a loved one attempt suicide?: 

If yes, date of attempt? 
(ie mm/dd/19yy) 

 If the injured is not living, what was the date of death?

Was death a result of suicide?:

Yes No

 If injured is living, what physical injury resulted from the suicide attempt?

 What other injury resulted from taking the medication?

Did you take Paxil while you were pregnant?

Yes No

If yes, was your child born with birth defects?

Yes No

What birth defects did your child experience?

 What date did the injury occur?
(ie mm/dd/19yy) 

  What city and state did injury occur?

  Do you currently have an attorney assisting you with this matter?

Yes No

Please briefly describe your legal concern
 
 I understand that submitting this form does not create an attorney client relationship: Agree


Submit by pressing button below