Heart Device (ICD) FDA Recall: Defibrilators

FREE GUIDANT DEFIBRILLATOR LAWSUIT CLAIM REVIEW

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Guidant Heart Defibrillator Claim Review
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Defendant: (who caused the harm?)	GUIDANT DEFIBRILLATOR PACEMAKER
*Title: (describe the nature of your complaint in one short sentence)
What is the best way to contact you? (time, phone number, etc)
Additional contact information:
Date of Birth: (mm dd yy)
Whom are you inquiring on behalf of? (self, minor, other)
If you are NOT inquiring on your own behalf, what is your relationship?
Is the person deceased?	Yes No
If deceased, what is the cause of death as stated on the death certificate?
Date of Death:
Was there an autopsy performed?	Yes No
During what period of time was the pacemaker implanted? Start date:
End date:
For what diagnoses or condition was the defibrillator prescribed?
Which Guidant Debfibrillator was Implanted? Ventak Prizm AVT Prizm 2 DR Contak Renewal Contak Renewal 2 Vitality AVT Renewal 3 AVT Renewal 4 AVT ICD Other Debfibrillator Don't Know If other, what is the name of defibrillator that was used? Date pacemaker was implanted: Is the defibrillator still implanted? Yes No What medical condition caused prompted the use of a defibrillator? Please describe any problems or injuries caused by the defibrillator, e.g., electrical shock, audible beeping, irregular heartbeat, but no device response. YOUR INFORMATION Fields marked * are required
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FREE GUIDANT DEFIBRILLATOR LAWSUIT CLAIM REVIEW

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