In Re: Prempro Products et al

Filing 1948

ORDER Re: Fact Sheet procedures. Signed by Judge William R. Wilson, Jr on 1/13/09. (mkf)

Download PDF
IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF ARKANSAS WESTERN DIVISION IN RE: PREMPRO PRODUCTS LIABILITY LITIGATION : : : : MDL DOCKET NO. 4:03-CV-1507-WRW ALL CASES ORDER Re: FACT SHEETS Over the years, repeatedly questions have been raised as to who should be served with completed Fact Sheets and how. After a review of the record, I am not sure this procedure was ever explicitly set out (at least, not in one concise Order), so I will do so now. Fact Sheets must be served as set out below: 1. Each plaintiff must complete and serve each defendant with her completed Fact Sheet within 90 days after her Conditional Transfer Order becomes final. However, if the parties wish to stipulate among themselves to a different start date, they may.1 2. 3. Fact Sheets are not to be filed with the Court. Each plaintiff must serve hard copies of completed Fact Sheets on defendants' lead and liaison counsel.2 Their addresses are: Lead Counsel: Mr. Lane Heard Williams & Connolly LLP 725 Twelfth Street, N.W. Washington, DC 20005 Liaison Counsel: Ms. Lyn Pruitt Mitchell, Williams, Selig, Gates & Woodyard, PLLC 425 West Capitol Ave, Suite 1800 Little Rock, AR 72201 1 See Doc. No. 1093. See Doc. No. 377. 1 2 4. In addition to serving hard copies, each plaintiff must electronically serve her Fact Sheet to all concerned defendants.3 For electronic service on manufacturer defendants, plaintiffs may email the electronic copies to hrtfactsheets@wc.com -- Wyeth has agreed distribute the electronic copies to other manufacturer defendants. Plaintiffs will remain responsible for serving electronic copies on all non-manufacturer defendants. 5. For convenience, a copy of the Fact Sheet is attached to this Order. IT IS SO ORDERED this 13th day of January, 2009. /s/ Wm. R. Wilson, Jr. UNITED STATES DISTRICT COURT 3 See Id. 2 IN THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF ARKANSAS WESTERN DIVISION In re: PREMPRO PRODUCTS LIABILITY LITIGATION : : : : : MDL Docket No. 4:03CV1507 WRW ALL CASES PLAINTIFF'S FACT SHEET PLAINTIFF'S NAME: ____________________________________________________ This Fact Sheet and the attached List of Medical Providers and Other Sources of Information must be completed by each plaintiff in the ML Prempro Products Liability Litigation who used Hormone Therapy (HT) medications or who is the representative of a person or the estate of a deceased person who used HT. For each question, where the space provided does not allow for a complete answer, please attach additional sheets so that all answers are complete. Information provided by plaintiff within the fact sheet will only be used for purposes related to this litigation and such information will not be disclosed outside this litigation without plaintiff's written consent. Plaintiffs' Fact Sheet is completed pursuant to the Federal Rules of Civil Procedure governing discovery. Please note: HT = "hormone therapy drugs" I. A. CASE INFORMATION Please state the following for the civil action which you filed: 1. 2. 3. Case Caption: MDL Cause Number :__________________________________________ Please provide plaintiff's name and address: ____________________________________________________________ Name ____________________________________________________________ Street Address ____________________________________________________________ City, State, and Zip Code Page 1 4. Please state name, address, telephone number, fax number and e-mail address of principal attorney representing you. Attorney Name: Firm: Telephone Number: FAX Number: E-Mail Address: B. If you are completing this questionnaire in a representative capacity (e.g., on behalf of the estate of a deceased person or a minor), please complete the following: Your name: ______________________________________________________________ Street Address: ___________________________________________________________ City: _____________________________ State: ___________ Zip: _________________ In what capacity are you representing the individual? If you were appointed by a court, state the: State, Court Term and Number Date of Appointment Your relationship to deceased or represented person: _____________________________ State the date of death of the decedent._________________________________________ [If you are completing this questionnaire in a representative capacity, please respond to the remaining questions with respect to the person who used HT medications. Those questions using the term "You" refer to the person who used the HT medications. If the individual is deceased, please respond as of the time immediately prior to his or her death unless a different time period is specified.] C. 1. Claim Information Do you claim that you have suffered a bodily injury as a result of the use of HT No _____ medications? Yes Page 2 If the answer to the foregoing question is yes, state the nature of the bodily injury or injuries which you claim. ________________________________________________________________________ 2. If you do not claim you have suffered a bodily injury as a result of the use of HT medications, state how you have been injured. _________ 3. ___________________________________________ Identify by name, specialty, address and phone number any doctor(s) who told you that you are injured. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ D. Hormone Therapy used - Identify by complete brand name and/or trade name the HT medications you claim caused your injuries, including the specific type of the medication or product, a description of what the medication looked like, the NDC codes for the medication, and the dates of your use. Answers may be provided by attaching pharmacy records and/or providing NDC codes of any HT medication(s) ingested. E. Prescribing Physicians - Identify by name, specialty, and address the doctor(s) who prescribed these HT medications for you and, for each doctor, provide the dates during which he or she prescribed the HT medication. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ 1. Page 3 2. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ 3. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ F. Samples - Did you ever receive sample HT products from any of your healthcare providers? Yes _____ No _____ If yes, please state: 1. From what doctor? 2. When? 3. Identify the specific products included in the samples. II. PERSONAL INFORMATION A. Last Name B. First Name Middle Initial Maiden or other names used or by which you have been known, and the dates during which you were known by such names: C. Current or last employer: Name Street Address, City, State and Zip Code Page 4 Dates of Employment Occupation D. E. Social Security Number: Do you have a driver's license? Yes _____ No _____ Have you ever had your driving privileges suspended or limited based on your health or physical condition? Yes _____ No _____ If so, when and for what reason(s)? ____________________________________ _________________________________________________________________ F. G. H. Date and Place of Birth: Sex: Male _____ Female Because many diseases and conditions related to this litigation may be more or less prevalent in certain racial and ethnic groups, please identify your racial and ethnic background: Racial and Ethnic Background: I. Have you ever served in any branch of the military? 1. Branch and dates of service: Yes _____ No _____ 2. Were you discharged for any reason relating to your health or physical condition: Yes _____ No _____ If yes, state what that condition was. Have you ever been rejected from military service for any reason relating to your health or physical condition? Yes _____ No _____ J. Have you ever filed a worker's compensation claim? If yes, please state: 1. Year claim was filed: Page 5 Yes _____ No _____ 2. 3. 4. 5. Where claim was filed: Claim/docket number, if applicable: Nature of claimed injury: Period of disability: [Attach additional sheets as necessary to describe more than one claim.] K. Have you ever made a social security disability claim? If yes, please state: 1. 2. 3. 4. Year claim was filed: Where claim was filed: Nature of disability: Period of disability: Yes _____ No _____ [Attach additional sheets as necessary to describe more than one clam.] L. Have you ever made any other form of disability claim? Yes _____ If yes, please state: Year claim was filed: Where claim was filed: Name of insurer/employer or other party to whom claim was made: __________________________________________________________________ Nature of disability: Period of disability: M. Have you ever been denied life insurance for reasons relating to your health? Yes _____ No _____ No _____ If yes, please state when, the name of the company and the company's stated reason for denial. Page 6 N. Within the last ten (10) years, have you filed a lawsuit or made a claim, other than in the present suit, seeking damages for personal injury or medical malpractice? Yes _____ No _____ If yes, state the state and county in which claim was filed, the caption, case name and/or names of adverse parties, and the civil action or docket number assigned to each such claim, action or suit. Have you ever filed a lawsuit or made a claim, other than in the present suit, seeking damages for the injuries you claim in this case? Yes _____ No _____ If yes, state the state and county in which claim was filed, the caption, case name and/or names of adverse parties, the injuries claimed, and the civil action or docket number assigned to each such claim, action or suit. O. Have you been convicted of, or pled guilty to, a felony within the last 10 years? Yes _____ No _____ If so, describe the crime or offense, the state and county in which convicted, and the outcome of the charge. P. Identify each address at which you have resided during the last ten (10) years, including time periods of residence. Q. Have you had access to a computer at any time over the past five (5) years? Yes ______ No ______ If "yes," then answer the following: 1. Did you ever visit any website containing information regarding hormone therapy or the treatment of menopausal systems? Yes ______ No ______ Page 7 2. 3. Did you ever visit any chat rooms? Yes ______ No ______ Did you ever communicate via email or chat room regarding hormone therapy or the treatment of menopausal systems? Yes ______ No ______ III. EMPLOYMENT HISTORY Identify each employer since 1990, dates of each such employment and positions held. If you are making a claim for lost wages in this case, also list, for each position, your salary and/or other compensation received: Have you ever been out of work for more than thirty (30) days for reasons related to your health, including pregnancy? Yes _____ No _____ If yes, please state the dates, employer and health condition: IV. EDUCATIONAL HISTORY Identify each high school, vocational school, college, university or other post-secondary educational institution you have attended, the dates of attendance, and diplomas or degrees awarded: V. FAMILY INFORMATION a. Have you ever been married? Yes _____ No _____ b. If you have been married, for each spouse, state: i. Spouse's name: ii. Dates of marriage: iii. Spouse's date of birth: Page 8 iv. Spouse's occupation: v. Spouse's address: c. Has your spouse filed a loss of consortium or other claim? Yes _____ No _____ d. Please provide the following information for your parents, grandparents, siblings and children: Name Relationship Date of Birth Va. 1. PREGNANCY HISTORY During pregnancy, did you experience any miscarriages? Yes _____ No ____ If yes, please list the approximate date of the miscarriage, state how many weeks you had been pregnant when the miscarriage occurred and the cause of any such miscarriage. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ 2. During pregnancy, did you experience any of the following: Toxemia: High blood pressure: Gestational diabetes: Page 9 Yes _____ Yes _____ Yes _____ No _____ No _____ No _____ Large babies (over 9 pounds): Yes _____ Pre-eclampsia: Premature labor(s): Premature birth(s): Yes _____ Yes _____ Yes _____ No _____ No _____ No _____ No _____ No _____ Small babies (6 lbs. or less): Yes _____ For each "yes" you have checked above, provide the dates and (if appropriate) treatment: 3. Were you placed on bed rest during any pregnancy? If yes, describe length of bed rest and reasons for it: Yes _____ No _____ 4. Did you take any hormones or medications during pregnancy? Yes _____ No _____ If yes, list medications, prescribing doctor, and reasons for taking: 5. How much weight did you gain during each pregnancy: 6. Did you breastfeed your children? If so, for how long did you breastfeed each child? Yes _____ No _____ 7. Were you ever treated for infertility? Yes _____ No _____ If yes, identify the dates of treatment, the medical provider(s) who treated you, and the treatment(s) undertaken, including any medications you took. 8. Is your blood type RH negative? Page 10 Yes _____ No _____ For each of your pregnancies, list the gynecologist, obstetrician, or other medical care provider who treated you and, for each time you gave birth, the hospital at which you delivered: 1. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ 2. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ 3. Name: ________________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Dates: __________________________ Hospital: _______________________________ VI. A. LIST OF HEALTHCARE PROVIDERS List the name and address of your current primary care physician(s) or provider: Name: _____________________________ Approximate dates: ___________________ Last known address: _______________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ B. Primary care physicians - To the best of your ability, identify each of the primary care physicians or providers who have treated you since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier. Page 11 1. Name: _____________________________ Approximate dates: ___________________ Last known address: _______________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 2. Name: _____________________________ Approximate dates: ___________________ Last known address: _______________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 3. Name: _____________________________ Approximate dates: ___________________ Last known address: _______________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ C. Ob/ Gyn Identify each obstetrician or gynecologist who has seen or treated you since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier, other than those you already listed earlier in response to questions about your pregnancies.: Name: _______________________________ Specialty: ________________________ 1. Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 2. Name: _______________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 3. Name: _______________________________ Specialty: ________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Page 12 D. In-patient treatment Identify each hospital where you have received inpatient treatment since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier. Name: ___________________________ Reason for treatment: ____________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 1. 2. Name: ___________________________ Reason for treatment: ____________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 3. Name: ___________________________ Reason for treatment: ____________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ E. Out-patient treatment Identify each hospital or healthcare facility or provider where you have received out-patient treatment (including emergency room treatment and outpatient surgery) or tests since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier: Name: __________________________________________________________________ Treatment or tests received: _________________________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 1. 2. Name: __________________________________________________________________ Treatment or tests received: _________________________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ Page 13 3. Name: __________________________________________________________________ Treatment or tests received: _________________________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 4. Name: __________________________________________________________________ Treatment or tests received: _________________________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 5. Name: __________________________________________________________________ Treatment or tests received: _________________________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ F. All doctors Identify each other physician or healthcare provider from whom you have received treatment, with whom you have consulted regarding your health, or who has examined you since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier: Name: __________________________________________________________________ Specialty & reason for consult: ______________________________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 1. 2. Name: __________________________________________________________________ Specialty & reason for consult: ______________________________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ Page 14 3. Name: __________________________________________________________________ Specialty & reason for consult: ______________________________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 4. Name: __________________________________________________________________ Specialty & reason for consult: ______________________________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ 5. Name: __________________________________________________________________ Specialty & reason for consult: ______________________________________________ Street address: ___________________________________________________________ City: __________________ State: _______ Zip: ____________ Phone: _____________ G. Pharmacy Identify each pharmacy, drugstore and/or other supplier (including mail order) where you have had prescriptions filled or from which you have ever received any prescription medication since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier. Also list all pharmacy, drugstore and/or other supplier (including mail order) where you remember having prescriptions filled for oral contraceptives or from which you ever remember receiving oral contraceptives (birth control pills). Name: __________________________________________________________________ Medication and Reason for Prescription: _______________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 1. 2. Name: __________________________________________________________________ Medication and Reason for Prescription: _______________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Page 15 Zip: __________________ 3. Name: __________________________________________________________________ Medication and Reason for Prescription: _______________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 4. Name: __________________________________________________________________ Medication and Reason for Prescription: _______________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ 5. Name: __________________________________________________________________ Medication and Reason for Prescription: _______________________________________ Street address: ___________________________________________________________ City: _________________________ State: ___________ Zip: __________________ H. Insurance carrier - Identify each health insurance carrier which provided you with medical coverage and/or pharmacy benefits for the last twenty years, with the named insured and named insured's social security number. Carrier Policy Number Named Insured Social Security No. VII. CURRENT MEDICAL CONDITION A. Do you currently suffer from any physical injuries, illnesses or disabilities that you No _____ believe were caused by Hormone Therapy? Yes If yes, identify the injury, illness, or disability, symptoms, date(s) of onset and date(s) of diagnosis: Injury, illness or disability: _________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Page 16 Symptoms: ______________________________________________________________ Date(s) of onset: __________________________________________________________ Date(s) of diagnoses: ______________________________________________________ Physician Name by whom first diagnosed:______________________________________ Specialty: _______________________________________________________________ Address (if not otherwise provided): __________________________________________ B. Do you currently suffer from any physical injuries, illnesses or disabilities other than those that you believe were caused by HT medications? Yes _____ No _____ If yes, identify the injury, illness, or disability, symptoms, date(s) of onset and date(s) of diagnosis: Injury, illness or disability: _________________________________________________ Symptoms: ______________________________________________________________ Date(s) of onset: __________________________________________________________ Date(s) of diagnoses: ______________________________________________________ Physician Name by whom first diagnosed:______________________________________ Specialty: _______________________________________________________________ Address (if not otherwise provided): ________________________________________ VIII. PLAINTIFF'S HEALTH HISTORY A. Body measurements Current height: _______________________ Current weight:____________________ Weight at time of injury:____________ Weight when first prescribed HT: ___________ Lowest weight during adulthood (and date): Highest weight during adulthood (and date): Current waist measurement: ___________ Current hip measurement: Page 17 Has any healthcare provider ever recommended any change in your habits (for example, losing weight, lowering blood pressure, getting exercise, reducing cholesterol)? Yes _____ No _____ If yes, please list the recommendation, the date(s) made, and the healthcare provider: ________________________________________________________________________ ________________________________________________________________________ B. Menstrual History: Date and age of first menstrual period: Date and age of last menstrual period: Were your menstrual cycles regular? If yes, average length of cycle: _________ Yes _____ No _____ _ Average length of period: ______________ If no, describe your cycles and periods: ________________________________________ ________________________________________________________________________ Did you ever experience menstrual problems (including irregular periods, painful periods, or absence of periods) for which you sought medical treatment or advice? Yes ___ No __ If yes, please give dates and description of problem, the provider consulted, and any treatment: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Have you ever been diagnosed with polycystic ovary syndrome? Yes _____ No _____ If yes, please identify healthcare provider who diagnosed you, dates of diagnosis, and treatment: ________________________________________________________________________ ________________________________________________________________________ Have you ever been diagnosed with endometriosis? Yes _____ No _____ Page 18 If yes, please identify healthcare provider who diagnosed you, dates of diagnosis, and treatment: ________________________________________________________________________ ________________________________________________________________________ Have you ever been diagnosed with fibroids anywhere in your body? Yes ___ No ____ If yes, please identify healthcare provider who diagnosed you, dates of diagnosis, and treatment: ________________________________________________________________________ ________________________________________________________________________ C. Menopause History: Age at menopause: Pre-menopausal symptoms: ________________________________________________________________________ Symptoms at menopause experienced before starting hormone therapy: ________________________________________________________________________ Symptoms of menopause experienced after ending hormone therapy: ________________________________________________________________________ ________________________________________________________________________ D. Mammogram History (Answer questions in this Section ONLY if you are making a claim for breast cancer): Did you have any mammograms before you reached menopause? Yes _____ No _____ If yes, list dates, healthcare facility (by name and address) where you received each mammogram, and results of the mammogram: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Page 19 How frequently have you had a mammogram since menopause? ________________________________________________________________________ For each such mammogram, list dates, healthcare facility (by name and address) where you received each mammogram and results of the mammogram: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Has a healthcare provider ever recommended follow-up testing as a result of a mammogram or have you undergone such testing? Yes _____ No _____ If yes, describe the follow-up, including dates, type of follow-up, and location (by name and address) of such follow-up: ________________________________________________________________________ ________________________________________________________________________ Do you do breast self-exams? Yes _____ No _____ For how long have you done these exams and with what frequency? ________________________________________________________________________ Have you ever found anything during a self-exam? If yes, please explain, including relevant dates: ________________________________________________________________________ ________________________________________________________________________ Have you ever been told that you have dense breasts? Yes _____ No _____ Yes _____ No _____ If yes, please identify the healthcare practitioner who informed you and the date(s) on which you were given this information: ________________________________________________________________________ Have you ever been told you have fibrocystic breasts? Yes _____ No _____ If yes, please identify the healthcare practitioner who informed you and the date(s) on which you were given this information: ________________________________________________________________________ Page 20 E. Medications: Do you currently take or have you ever taken oral contraceptives (i.e. birth control pills) or other hormones (for any reason, such as birth control, irregular period, etc.) Yes _____ No _____ Don't Know _____ Do you currently take, or have you taken since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier, any of the following: 1. Anticoagulants (such as aspirin, Coumadin, warfarin, fragmin or heparin) Yes _____ No _____ Don't Know _____ 2. Heart medications: Yes _____ 3. No _____ Don't Know ____ Blood pressure medication: Yes _____ No _____ Don't Know ____ 4. Ephedra: Yes _____ No _____ Don't Know ____ 5. Diet Medications: Yes _____ No _____ Don't Know ____ 6. Diuretics (fluid retention medications) Yes ___ No ___ Don't Know ___ 7. Any other prescription medicines regularly taken since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier: Yes _____ No _____ Don't Know ____ Page 21 For each "yes" you have checked above, including oral contraceptives, provide the precise name of the medication/substance, the time period(s) you took it (including the dates first and last taken), and the reasons your physician prescribed it, if known: Medication Date First Taken Date Last Taken Reason for Prescription/Use F. 1. Smoking history (check wherever appropriate) Have you ever smoked cigarettes? Yes _____ No _____ (If no, skip to F. 5) State amount smoked:____ packs per day for ________ years, during the years ________ to _________. 2. Do you currently smoke cigarettes? Yes _____ No _____ If yes, state amount smoked: _____ packs per day If no, state date on which smoking ceased: _____________________________________ 3. Were you a cigarette smoker when you began, or during, hormone therapy? Yes ___ No ___ If yes, state amount smoked during that time: _______ packs per day 4. At the time that you sustained the injuries alleged in this lawsuit, were you a smoker of cigarettes? Yes _____ No _____ If yes, state amount smoked at that time: _____ packs per day 5. Have you ever smoked cigars or pipe tobacco? Page 22 Yes _____ No _____ (If no, skip to G) If yes, State amount smoked:____ cigars/pipes per day for ________ years, during the years ________ to _________. 6. Do you currently smoke cigars or pipe tobacco? Yes ____ No _____ If yes, state amount smoked: _____ cigars/pipes per day If no, state date on which smoking ceased: _____________________________________ 7. Were you a pipe or cigar smoker when you began, or during, hormone therapy? Yes ___ No ___ If yes, state amount smoked during that time: ______ cigars/pipes per day 8. At the time that you sustained the injuries alleged in this lawsuit, were you a smoker of cigars or pipe tobacco? Yes _____ No _____ If yes, state amount smoked at that time: _____ cigars/pipes per day G. Drinking History Do you currently drink alcohol (beer, wine, whiskey, etc.)? Yes _____ No _____ If yes, check which represents your typical alcohol consumption? _____ _____ _____ _____ _____ 1 2 drinks per day 1 - 6 drinks per week 6 10 drinks per week 10 or more drinks per week Other (explain: ) H. Caffeine History Do you currently drink caffeinated beverages (coffee, tea, sodas, etc.)? Yes _____No _____ If yes, check which represents your current caffeine consumption for each type of caffeine drink: Beverage: _________________________ _____ 1 3 drinks per day _____ 3 5 drinks per day _____ 6 or more drinks per day Beverage: ________________________ _____ 1 3 drinks per day _____ 3 5 drinks per day _____ 6 or more drinks per day Page 23 I. Prior medical problems: To the best of your knowledge, have you ever experienced or been diagnosed or treated for any of the following? 1. 2. Cancer Having BRCA1 or BRCA2 Gene or any other factor increasing your risk of breast or ovarian cancer Ectopic pregnancy Abnormal pap smear Abnormal mammogram "Bad" mammogram Obesity Autoimmune disease or condition such as lupus, rheumatoid arthritis, psoriasis, scleroderma or mixed-connective tissue disorder Yes Rheumatological condition Diabetes Glucose Intolerance Vasculitis High triglycerides Arthritis Low HDL Cholesterol High LDL Cholesterol Increased c-reactive protein (CRP) levels Antiphospholipid antibodies Ovarian cysts Radiation treatments Osteoporosis Low bone mineral density Gall bladder disease or problems Thyroid Disease or problems Page 24 Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Unknown Yes Yes Yes No No No Yes No Yes Unknown Unknown Unknown No Unknown 3. 4. 5. 6. 7. 8. Unknown No Unknown No No No No No No No No No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. Hypertension or high blood pressure Aneurysm Abnormality of blood vessels or circulatory system Blood clots or thrombosis Blood disorders or dyscrasias (abnormal blood cells) Yes Yes Yes Yes Yes No No No No No Unknown Unknown Unknown Unknown Unknown Hypercoagulable conditions (i.e. conditions, whether genetic or acquired, in which your blood clots too much) Yes Any other blood clotting disorder Stroke of any type (e.g., hemorrhagic stroke, ischemic stroke, intracranial hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, lacunar stroke) Transient ischemic attach (TIA) Heart disease or condition Cerebrovascular disease or condition Heart valve disease or abnormality Heart attack Mitral valve prolapse Atherosclerosis (clogged arteries or plaque in arteries) High cholesterol Irregular heart beat, atrial fibrillation, arrhythmia, heart palpitations, tachycardia (rapid heart beat), bradycardia (slow heart beat) Angina (chest pain) Bleeding disorder Phlebitis Deep Vein Thrombosis (DVT) Page 25 Yes No No Unknown Unknown 31. 32. Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown 33. 34. 35. 36. 37. 38. 39. 40. 41. Yes Yes Yes Yes Yes No No No No No Unknown Unknown Unknown Unknown Unknown 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. Portal Vein Thrombosis Pulmonary Embolism (PE) Macular degeneration Migraine Peripheral vascular disease Varicose veins Retinal Bleed Kidney disease Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown If you responded yes to any of the above, please identify the condition, the date of onset or occurrence and state the name of the physician or other person who made the diagnosis or informed you of the condition (and, if not provided in the accompanying list, the address of the physician or the other person), and any treatment prescribed or given. 1. Condition: Onset: Name and address of diagnosing physician or other person:__________________ __________________________________________________________________ Generic name, brand name, strength and daily dose of any medication prescribed: __________________________________________________________________ __________________________________________________________________ 2. Condition: Onset: Name and address of diagnosing physician or other person:__________________ __________________________________________________________________ Generic name, brand name, strength and daily dose of any medication prescribed: __________________________________________________________________ __________________________________________________________________ Page 26 3. Condition: ________________________________________________________ Onset: Name and address of diagnosing physician or other person:__________________ __________________________________________________________________ Generic name, brand name, strength and daily dose of any medication prescribed: __________________________________________________________________ __________________________________________________________________ J. Family Medical History - Please indicate whether, to the best of your knowledge, your parents, siblings, children or grandparents have experienced, been diagnosed with or treated for any of the following conditions. If you are making a claim for any kind of cancer, you should put a check mark in each of the conditions under category "A" to indicate whether any of your parents, siblings, children or grandparents have experienced, been diagnosed with, or treated for any of the conditions. If you are making a claim for any cardiovascular condition, such as stroke(embolism, thrombosis), blood clots, or heart attack, you should put a check mark in each of the conditions under category "B" to indicate whether any of your parents, siblings, children or grandparents have experienced, been diagnosed with, or treated for any of the conditions. Category A (Claim for Cancer) 1. 2. Cancer Having BRCA1 or BRCA2 Gene or any other factor increasing your risk of breast or ovarian cancer Ectopic pregnancy Abnormal pap smear Abnormal mammogram "Bad" mammogram Obesity Yes No Unknown Yes Yes Yes Yes Yes Yes No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown 3. 4. 5. 6. 7. 8. Autoimmune disease or condition such as lupus, rheumatoid arthritis, psoriasis, scleroderma or mixed-connective tissue disorder Yes Page 27 No Unknown 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Rheumatological condition Diabetes Glucose Intolerance Vasculitis High triglycerides Arthritis Low HDL Cholesterol High LDL Cholesterol Increased c-reactive protein (CRP) levels Antiphospholipid antibodies Ovarian cysts Radiation treatments Osteoporosis Low bone mineral density Gall bladder disease or problems Thyroid Disease or problems Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Category B (Claim for Cardiovascular Injury) 1. 2. 3. 4. 5. 6. Hypertension or high blood pressure Aneurysm Abnormality of blood vessels or circulatory system Blood clots or thrombosis Blood disorders or dyscrasias (abnormal blood cells) Yes Yes Yes Yes Yes No No No No No Unknown Unknown Unknown Unknown Unknown Hypercoagulable conditions (i.e. conditions, whether genetic or acquired, in which your blood clots too much) Yes Any other blood clotting disorder Yes No No Unknown Unknown 7. Page 28 8. Stroke of any type (e.g., hemorrhagic stroke, ischemic stroke, intracranial hemorrhage, intracerebral hemorrhage, subarachnoid hemorrhage, lacunar stroke) Transient ischemic attach (TIA) Heart disease or condition Cerebrovascular disease or condition Heart valve disease or abnormality Heart attack Mitral valve prolapse Atherosclerosis (clogged arteries or plaque in arteries) High cholesterol Irregular heart beat, atrial fibrillation, arrhythmia, heart palpitations, tachycardia (rapid heart beat), bradycardia (slow heart beat) Angina (chest pain) Bleeding disorder Phlebitis Deep Vein Thrombosis (DVT) Portal Vein Thrombosis Pulmonary Embolism (PE) Migraine Peripheral vascular disease Varicose veins Retinal Bleed Kidney disease Obesity Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown 9. 10. 11. 12. 13. 14. 15. 16. 17. Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. Page 29 30. Autoimmune disease or condition such as lupus, rheumatoid arthritis, psoriasis, scleroderma or mixed-connective tissue disorder Yes Rheumatological condition Diabetes Glucose Intolerance Vasculitis High triglycerides Arthritis Low HDL Cholesterol High LDL Cholesterol Increased c-reactive protein (CRP) levels Antiphospholipid antibodies Radiation treatments Osteoporosis Low bone mineral density Gall bladder disease or problems Thyroid Disease or problems Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No No No No No No No No No No Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown Unknown 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. If you answered yes to any of the preceding, please identify the person(s) who experienced, was diagnosed with or was treated for that condition. 1. Person: ______________________________ Relationship: Condition: ___________________________ Date of Onset: Generic name, brand name, strength and daily dose of any medication prescribed: ________________________________________________________________________ Name and address of diagnosing physician or other person:________________________ ________________________________________________________________________ Page 30 Did this person die from the condition or from complications related to the condition? Yes _____ No _____ If so, date of death: _____________________________________________________ 2. Person: ______________________________ Relationship: Condition: ___________________________ Date of Onset: Generic name, brand name, strength and daily dose of any medication prescribed: ________________________________________________________________________ Name and address of diagnosing physician or other person:________________________ ________________________________________________________________________ Did this person die from the condition or from complications related to the condition? Yes _____ No _____ If so, date of death: _____________________________________________________ K. Emotional claims - Do you claim psychological, psychiatric (including depression), cognitive, or emotional injury as a consequence of using any hormone therapy medications or as a consequence of the physical injuries you claim were caused by hormone therapy? Yes No _____ If yes, identify the following with respect to any psychological, psychiatric (including depression) or emotional problem which you claim was caused by the use of the HT medications at issue. Name and address of each person who treated you: Street Address (if not otherwise provided): _____________________________________ Condition(s) for which treated: ______________________________________________ When treated: ____________________________________________________________ Please state whether you have experienced or been treated for any psychological, psychiatric (including depression), cognitive, or emotional problem PRIOR to the use of the HT medications at issue. Yes _____ No _____ If yes, please state: Name and address of each person who treated you: Street Address (if not otherwise provided): _____________________________________ Page 31 Condition(s) for which treated: ______________________________________________ When treated: ____________________________________________________________ L. 1. Medical Treatments - Please indicate whether you have received any of the following treatments: Heart, lung or other chest surgery: For what condition? When? _________________________________________________________________ Treating physician: ________________________________________________________ Yes _____ No _____ 2. Treatment for heart attack or angina: For what condition? Yes _____ No _____ When? _________________________________________________________________ Treating physician: ________________________________________________________ 3. Pacemaker: Yes _____ No _____ For what condition? When? _________________________________________________________________ Treating physician: ________________________________________________________ 4. By-pass surgery: For what condition? When? _________________________________________________________________ Treating physician: ________________________________________________________ 5. Vascular surgery: For what condition? When? _________________________________________________________________ Treating physician: ________________________________________________________ Page 32 Yes _____ No _____ Yes _____ No _____ 6. Any other surgery: For what condition? Yes _____ No _____ When? _________________________________________________________________ Treating physician: ________________________________________________________ IX. USE OF HT MEDICATIONS Please complete the following chart with respect to each HT medication you recall taking during the period beginning ten (10) years before your injury through to the present. Answer: Plaintiff refers Defendants to her pharmacy records and the records of her prescribing physicians which describe in greater detail her use of hormone therapy. To the best of Plaintiff's recollection, Plaintiff used the following hormone therapy drugs: Generic Name Brand Name Description Approximate Dates of First and Last Use Prescribed by Manufacturer or Drug Company and NDC No. Condition(s) for which HT medication was prescribed XI. A. THE INJURY On what date and time did you first experience any symptoms you believe are related to the injury/ies alleged in your Complaint? (If you are claiming more than one injury, please copy this page and fill out for each injury.) ________________________________________________________________________ Page 33 B. In what city and state were you when you experienced those symptoms? ________________________________________________________________________ C. Were there any witnesses to the symptoms identified above? If so, state their name, addresses, phone numbers and relationship to you. ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ D. When did you first contact a doctor or healthcare professional concerning this injury? ________________________________________________________________________ E. Who was the first such contact? ________________________________________________________________________ ________________________________________________________________________ XII. 1. INJURY CLAIMS Have you had discussions with any physician(s) about whether your condition is related to the use of HT medications? Yes _____ No _____ Don't know _____ If yes, please identify: Name of doctor: Address: ________________________________________________________________ Specialty: _______________________________ Date of discussion: and, check one of the following: 1. 2. 3. 4. 5. 6. _____ I was told my condition is related to the use of HT medications. _____ I was told my condition is not related to the use of HT medications. _____ I was told my condition may be related to the use of HT medications _____ I was told by the doctor that he or she does not know whether my condition is related to the use of HT medications. _____ I don't recall what I was told. _____ Other: (describe discussion regarding HT medications) (If discussed with more than one doctor, please copy and complete Question 1 for each) Page 34 2. Lost earnings - If you claim or expect to claim that you lost earnings or suffered impairment of earnings capacity as a result of any condition that you believe was caused by your HT medication, complete the following information with respect to your employment for the period beginning five (5) years before your injury through to the present. Employer Address Type of Business/Position Dates of Employment Salary State the total amount of time which you have lost from work as a result of any condition which you claim was caused by your use of HT medications and the amount of income which you lost. ________________________________________________________________________ ________________________________________________________________________ State your earned income for each of the past five years. Year $ $ $ $ $ Income Page 35 3. Medical Expenses - Have you paid or incurred any medical expenses, including amounts billed or paid by insurers and other third party payors, which are related to any condition which you claim was caused by your use of HT medications for which you seek recovery in the action which you have filed? Yes _ ____ No _____ If yes, please state the total amount of such expenses at this time. $ _________________ Plaintiff also refers Defendant to Plaintiffs' medical bills for a detailed and accurate accounting of all medical expenses. 4. Fact witnesses - Please identify all persons who you believe possess information concerning your injury and/or your current medical conditions and for each, state their name, address, telephone number and a description of the information you believe they possess. Name: _________________________________________________________________ Address: ________________________________________________________________ City: _________________ State: ________ Zip:__________ Phone: ______________ Information they possess: __________________________________________________ _______________________________________________________________________ 1. 2. Name: _________________________________________________________________ Address: ________________________________________________________________ City: _________________ State: ________ Zip:__________ Phone: ______________ Information they possess: __________________________________________________ _______________________________________________________________________ 3. Name: _________________________________________________________________ Address: ________________________________________________________________ City: _________________ State: ________ Zip:__________ Phone: ______________ Information they possess: __________________________________________________ _______________________________________________________________________ Page 36 4. Name: _________________________________________________________________ Address: ________________________________________________________________ City: _________________ State: ________ Zip:__________ Phone: ______________ Information they possess: __________________________________________________ _______________________________________________________________________ Page 37 VERIFICATION I,_______________________, declare under penalty of perjury that all of the information provided in this Plaintiff's Fact Sheet is true and correct to the best of my knowledge, information and belief and that I have supplied all the documents requested in Part XIII of this Plaintiff's Fact Sheet, to the extent that such documents are in my possession or in the possession of my lawyers, and that I have signed and supplied the authorizations attached to this Verification. Further, I acknowledge that I have an obligation to supplement the above responses if I learn that they are in some material respects incomplete or incorrect. ___________________________________________ Signature ____________________ Date Page 38 XIII. DOCUMENTS The judge requires you to provide a copy of any of the following documents that you have in your possession. I have tried to give you an explanation for each item and what materials are specifically being requested. Note that you are not supposed to create materials but merely provide a copy of documents if they are in your current possession. 1. Authorizations - Please sign and attach to this Fact Sheet the authorizations for the release of records appended hereto. Notes: You must sign the attached HIPAA Medical Authorization which permits the drug companies to get copies of your medical records. You have already signed a similar document for our office but this authorization is specifically for the drug companies. THIS DOCUMENT MUST BE RETURNED WITH YOUR PAPERWORK. 2. Documents in your possession - If you have any of the following materials in your custody or possession, please attach a copy to this Fact Sheet. A. If you have been the claimant or subject of any worker's compensation, Social Security or other disability proceeding, all documents relating to such proceeding. Notes: If you have any documents from a compensation or disability claim, please send us copies of those materials. B. All diagnostic tests or test results including original films or video of ultrasounds, mammograms, x-rays, echocardiograms, angiograms, CT-scans, MRIs, MRAs or electroencephalograms taken since five (5) years before you started taking hormone therapy OR since ten (10) years before the occurrence of the earliest injury you complain of in this lawsuit, whichever date is earlier. Notes: If you have actual copies of mammogram films or a videotape of an echocardiogram, you must send us those materials. C. Copies of all documents from physicians, healthcare providers or others relating to the use of HT medications, or to any condition you claim is related to the use of HT medications. Notes: If you have documents from any of your doctors which refer to or detail hormone therapy or your use of such medications, please provide those materials to us. D. All documents constituting, concerning or relating to product use instructions, product warnings, package inserts, pharmacy handouts or other materials distributed with or provided to you in connection with your use of HT medications. Notes: This request asks for copies of any materials that you got from your doctor or the pharmacy which contain warnings or instructions about hormone therapy drugs. This would include the white typed document that is often stapled to your pharmacy bag when you pick up your prescription or any printed information about hormone therapy drugs that any doctor gave to you. E. Copies of advertisements or promotions for HT medications and articles discussing menopause or hormone therapy. Notes: This request asks for actual copies of ads for hormone therapy drugs. If you saved copies of any such advertisement from a magazine or journal, please provide us with these documents. F. Copies of the entire packaging, including the bottle, box and label for the HT medication you allege caused you injury and any remaining medication. (Plaintiffs must maintain the originals of the items requested in this subpart.) Notes: This request asks you to provide any unused pills in your possession. Please check your medicine cabinet. If you still have an old bottle with left over hormone therapy pills or old sample packs, please send it to us. G. All statements obtained from or given by any person having knowledge of facts relevant to the subject of this litigation. Notes: It is unlikely that you have any documents responsive to this request because it asks for actual written statements of a fact witness about your injuries. However, if you have a statement that meets this description, please send it to us. H. All documents relating to your purchase of HT medications, including, but not limited to, receipts, prescriptions or records of purchase. Notes: If you have copies of receipts, invoices, cancelled checks, credit card statements or materials which show how much you paid for your hormone therapy medications, please provide those to us. I. All documents known to you and in your possession which mention HT or any alleged health risks or hazards related to HT in your possession at or before the time of the injury alleged in your Complaint. Notes: This request is for any documents that you had BEFORE you got injured which mention hormone therapy or its risks J. All documents in your possession which you believe were provided to you ( not to your lawyer) by any defendant. Notes: This request asks for any document that you received from any of the drug companies that made hormone therapy. So, if you ever wrote to Wyeth or Pharmacia and received a reply, you should provide us with a copy of that document. K. All photographs, drawings, journals, slides or videos relating to your alleged injury or your life after the incident. Notes: This request asks for photographic evidence of your injuries. It is VERY important that we provide this documentation. If you had breast cancer, and have any residual breast disfigurement (including unevenness in size or shape, mastectomy or lumpectomy scars, loss of nipple etc.), we need you to take a photograph of those injuries. You should stand before a blank background or pale colored wall and take a photograph of yourself from the neck down and with the camera focused on your breast area. You do not have to include your face in the picture. You should write your name and the date of the picture on the back of the photograph. You can use a regular camera, an instant camera or a digital camera and email us the photographs. L. Copies of all documents you (and not your lawyer) obtained from any source related to HT or to the alleged effects of ingesting HT products or medications. Notes: This request includes any printed materials that you got from the internet, your own research or any documents which talk about hormone therapy drugs. M. If you claim you have suffered a loss of earnings or earning capacity, your federal tax returns for each of the last five (5) years. Notes: If you were employed at the time of your injury, you should send us a copy of your federal income tax returns for each year from 1998 to 2003. If you do not have copies of those at your home, you should get copies from your accountant or tax advisor. This request should not be ignored just because you do not have a copy of the tax return actually in your home. You are obligated to get copies from your agent (which includes any tax form preparers). N. If you claim any loss from medical expenses, copies of all bills from any physician, hospital, pharmacy or other health care provider. Notes: If you have any bills, invoices, insurance payments or such medical expense information, you should provide that information. O. Copies of letters testamentary or letters of administration relating to your status as plaintiff. P. Decedent's death certificate and autopsy report (if applicable). Notes: If you are representing a deceased claimant, we will need legal proof of your ability to represent the decedent as well as a copy of the death certificate or autopsy report. Q. All journals, diaries, notes, letters, emails or other documents written by you or received by you which refer to your health or well-being, including any injuries or illnesses, or which refer to hormone therapy products or the risks or benefits of hormone therapy. Notes: This request does NOT ask for all of your diaries or calendars. It only asks for materials which refer to hormone therapy products. So do not send us every calendar from your refrigerator. But do send us any notes or journal entries that you have which refer to hormone therapy. Full Name: _____________________________ Social Security Number: ____________________ Date of Birth: _____________________________ IN RE: PREMPRO PRODUCTS LIABILITY LITIGATION MDL 1507 (E.D. Ark.) AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS In compliance with HIPAA, 45 CFR 164.508 To: Name of Entity: ___________________________________________________ Address: __________________________________________________________ City, State and Zip Code: ____________________________________________ You are hereby authorized to release my entire medical records file to the defendant or its authorized representative listed below ("Record Requestor"). This release authorized you to furnish copies of all medical records, including, but not limited to medical reports and notes, laboratory reports, pathology slides, reports, notes and specimens, radiographic films, CT scans, X-rays, MRI films, MRA films, correspondence, progress notes, prescription records, echocardiographic recordings, written statements, employment records, wage records, insurance, Medicaid, Medicare, and disability records, and medical bills regarding my injuries, diseases, diagnoses, or treatment, specifically including but not limited to III V/AIDS testing or treatment, drug testing, drug or alcohol abuse treatment, marriage or family counseling, as well as psychological/psychiatric treatment, notes and evaluations. Please note that this authorization is not limited in any way to the records or treatments specified above. This authorization does not permit you to disclose anything other than documents and records to anyone. This authorization is being given at my request in conjunction

Disclaimer: Justia Dockets & Filings provides public litigation records from the federal appellate and district courts. These filings and docket sheets should not be considered findings of fact or liability, nor do they necessarily reflect the view of Justia.


Why Is My Information Online?