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Name:
Phone:
() -
E-mail:
State:
Name of Injured Person:
Injured Person's Date of Birth:
Why was Strattera prescribed?
Please explain any problems and/or reactions that you have experienced as a result of taking this drug:
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Do you have a Strattera case?

Do you need a lawyer familiar with the issues in Strattera litigation to pursue your Strattera case? If you or a family member has taken Strattera and suspects liver damage, contact a lawyer today for a free NO-OBLIGATION lawsuit inquiry.

CONTACT INFORMATION
First Name:
Last Name:
E-mail Address:
Phone: () - ext.
Address:
City:
State:
Zipcode:
Additional contact information such as country code, foreign addresses, or special instructions:
CASE INFORMATION
Injured Person's Date of Birth:
Why was Strattera prescribed?
Do you suffer from the following injuries:
Jaundice (yellow colored skin)
Dark urine (cola colored)
Upper right-sided abdominal tenderness (location of the liver)
Liver dysfunction
Severe liver damage such acute hepatitis
Swelling or hives
Upset stomach
Itchy skin
 Persistent flu-like symptoms
Decreased appetite
Nausea or vomiting
Dizziness
Tiredness
Mood swings
Painful urination
Sexual side effects such as decreased libido, impotence, ejaculation problems, and painful sexual intercourse
SUICIDE INFORMATION
Suicide:
Suicide
Attempted Suicide
Name of injured person:
Date of attempt or death:
Case of death (if applicable):
Was Strattera listed as part of the cause of death? Yes No
STRATTERA INFORMATION
On what date was the drug first prescribed?
How long did you take this drug?
How many miligrams did you take per day?
Please describe your case. Please explain any problems and /or reactions that you have experienced as a result of taking this drug:
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