| 1. Provide the name, address and phone number of the doctor(s) who prescribed Vioxx to you. |
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| 2. When was the Vioxx taken, in what quantities and for what condition? |
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| 3. State the nature of any cardiac condition or stroke you had that PRE-DATED the ingestion of Vioxx and the name, address and phone number of the doctor(s) who diagnosed it and the treatment you received. |
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| 4. State the nature of any cardiac condition or stroke you suffered AFTER the use of Vioxx, including name, address and phone number of the doctor(s) and other medical facilities that treated it. Include the nature of treatment you received, including hospitalizations. |
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| 5. Provide a summary of the medical costs incurred as a result of the treatment of any heart condition or stroke AFTER the ingestion of Vioxx. |
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| 6. Describe any disability resulting from any heart condition or stroke you suffered AFTER taking Vioxx. |
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| 7. Are you presently receiving medical treatment for any heart condition or stroke related to taking Vioxx? |
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| 8. Has your doctor recommended any future medical care or therapy related to taking Vioxx? |
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| 9. Have you been unable to work as a result of a heart condition or stroke suffered after taking Vioxx? If yes, please set forth the name and address of your employer at the time you became disabled and the earnings you claim you have lost. |
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