Avandia Questionnaire

Office Locations

Tallahassee
(Map and Directions )
3375-A Capital Circle N.E.
Tallahassee, FL 32308
Toll Free Phone: (877) ALL WE DO
Local Phone: (850) 553-HELP
or (850) 422-7773
Fax: (850) 422-3449

Key West
(Map and Directions )
608 Whitehead Street
Key West, FL 33040
Toll Free Phone: (877) ALL WE DO
Local Phone: (305) 294-4585
Fax: (305) 294-7822

Thomasville
(Map and Directions )
214 West Jackson Street
Thomasville, GA 31792
Toll Free Phone: (877) ALL WE DO
Local Phone: (229) 226-HELP
(229) 226-4357

What should I do if I or a loved one took Avandia?

Why should I consult with an attorney? If you, a friend or loved one have taken Avandia and experienced symptoms of a heart attack or stroke, you may be entitled to compensation.

We will be happy to evaluate a claim on your behalf. As with all our cases, no fees or costs will be charged to you unless we make a recovery on your claim.

While our firm has handled many similar cases against drug manufacturers, we understand the importance of maintaining your medical care. For this reason all claims will be against the manufacturer; we do not intend to sue your doctors or health care providers.

Name:
E-mail:
Phone:
Address:
City:
State:
Zip:

If you are responding for an Avandia user who has died of a heart attack or stroke:

Decedent's Name

What was the date of death?

Cause of death?

Age of the decedent?

When were you diagnosed with Diabetes?

How long have you been taking Avandia?

What dosage were you taking? mg per day

Has your physician told you to stop taking Avandia? Yes No

What is your date of birth?

Have you been diagnosed as having any of the following while taking Avandia?

Heart attack	Date Diagnosed (month/year):
Stroke	Date Diagnosed (month/year):
TIA	Date Diagnosed (month/year):
Blood clots	Date Diagnosed (month/year):

Have you experienced any of the follow symptoms while taking Avandia?

Headache
Chest pain
Stomach pain
Jaw pain

Dizziness
Nausea
High blood pressure
Fatigue

Shortness of breath
Heart burn
Swelling of the feet or legs

Prior to taking Avandia had you been under the care of a cardiologist? Yes No

Prior to taking Avandia had you been diagnosed as having a heart attack or stroke?

Heart attack	Date:
Stroke	Date:
Congestive Heart Failure	Date:

Were you taking medication for any of the following prior to or while you were taking Avandia?

High blood pressure
High cholesterol
Blood thinners
Nitroglycerine

Have you had any of the following tests:

EKG Date:

Echocardiogram Date:

Angiogram
Date:

Angioplasty Date:

Stress Test Date:

Thallium Stress Test Date: