Learn if You Have a Claim Against Johnson & Johnson, Ortho McNeil

Women Sue Maker of Birth Control Patch Ten women filed a lawsuit against Johnson & Johnson and its subsidiary Ortho McNeil on July 25, 2005, claiming the birth control device the company manufactures caused them to suffer strokes and blood clots.
Claimant Information

Are you submitting this information on behalf of yourself?	Yes No
Are you submitting this information on behalf of a family member?	Yes No
If yes, please provide the injured party's: Name
Age
Relationship
Ortho Evra Use

Date you began Ortho Evra:
Date you stopped Ortho Evra:
Medical Information

Has the injured party suffered from blood clots?	Yes No
Has the injured party suffered from heart attack?	Yes No
Has the injured party suffered from stroke?	Yes No
Has the injured party suffered from pulmonary embolism?	Yes No
Is the injured party deceased?	Yes No
If yes to any of the above, please state the date:
Additional comments:
Is the injured party presently covered by health insurance?	Yes No
Has the injured party previously retained an attorney for representation in this matter?	Yes No

Personal Information

First Name

Last Name

Street / Apt /

City, State Zip

Home Phone & Evening Phone (Same) . . & . .

E-Mail Address

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Date Issue/Problem

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