Zelnorm Sitemap:

First Name*:
Last Name*:
E-mail*:
Phone*:  -
Address:
 
City:
State:
Zip:
Dates you took Zelnorm:
From: 
To: 

Injuries Caused by Zelnorm:
 

Heart attack

Death

Other heart problems

Atrial Fibrillation

Irregular Heart Beat

Unstable Angina

Ventricular Fibrillation

Stroke
 Meningitis

Arrhythmia

Heart Murmur

Ischemic event
 Ventricular Tachycardia

 

Date of Injury/Diagnosis:

Symptoms (check all that apply):
Chest Pain
Weakness		 Difficulty Breathing
Shortness of Breath
 

Why were you given Zelnorm?:

Chronic Constipation
IBS (Irritable Bowel Syndrome)

Other

 

Please describe what happened?:

 
 
 

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