Remicade (Infliximab) Side Effects Lawsuits

If you or a loved one has been injured by Remicade you or they may have a legal claim against the manufacturers of Remicade. You may be able to obtain funds for further medical treatment from the injuries, compensation for pain, and your action will help prevent Centocor from marketing these dangerous drugs to unsuspecting consumers.

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Title:

First Name:

  M. I.

  

 Last Name:

 Address:

 City:

 State:

 Zip Code:

 Phone Number (day):

 Phone Number (eve):

Email Address 

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

 Title:

  

First Name:

   MI

  

Last Name:

What is the Injured's relationship to you?:

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

 Have you or they taken Remicade?:

 Yes No

Date(s) of use?

Do you have proof of taking Remicade
from a prescription bottle, pharmacy records or record from doctor?

  Yes   No

Have you or they been diagnosed with any of the following?

Multiple Sclerosis?:

  Yes No

Myelitis?:

  Yes No

Optic neuritis? 

  Yes No

 Tuberculosis?

  Yes No

 Lupus?

 Yes   No

Congestive Heart Failure? 

 Yes   No

 Lymphoma?

  Yes   No

 Date of Diagnosis?:

What other side effects have you or they been experiencing? 

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


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