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If you or someone you know has suffered adverse health effects from Vioxx or Celebrex, we urge you to fill out the form below. Let our Vioxx lawyers go over your case in order to determine whether you are eligible to monetary compensation. The fields marked with (*) are required.

Fields marked with (*) are required.

First Name*:
Last Name*:
Year Of Birth*:
Phone Number*:
Cell Phone:
Email Address*:
Address:
City:
State*: Zip:

How long have you been taking Vioxx?

Have you ever been hospitalized or had surgery related to taking Vioxx?
Yes No


Drugs Taken (check all that apply)

Vioxx
Bextra
Celebrex

Heart Attack? Yes No
Date:

Stroke? Yes No
Date:

Diagnosis of Stevens-Johnson Syndrome? Yes No
Date:

Were you taking the drug Vioxx/Bextra/Celebrex at the time you were diagnosed with your sroke, heart attack or Stevens-Johnson Syndrome?
Yes No

Were you addmitted to the hospital for your sroke, heart attack or Stevens-Johnson Syndrome? Yes No

Questions and Comments:

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