Mirena Lawsuits

Houston

3200 Travis : 3rd Floor
Houston, TX 77006
(713) 529-0025
(713) 751-0412 (fax)

Galveston

(409) 762-9090

Toll Free

888-529-4688

andrewsteinberg@lawyer.com
www.thesteinberglawfirm.com

Mirena

Free Case Review

Fill out the form below if you need additional information or want to discuss a potential claim with an attorney. All inquiries are kept strictly confidential.

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Contact Information
* Title:
* First Name:
* Last Name:
* Relationship to Mirena® User:
* Email Address:
* Phone:
* Phone (Cell):
* Address:
* City:
* State:
* Zip:

How would you prefer to be contacted?

Email Mail Phone
Case Information
Name of Mirena® User:
Date of birth of Mirena® patient (mm/dd/yyyy):
Age of patient when Mirena® was prescribed:

Did you or a loved one experience any of the following side effects or complications after using Mirena®?

Perforation of the Uterine Wall
Migration of the IUD to Outside the Uterus
Expulsion of the Mirena IUD
Infection
Complications that Result in Surgery to Remove Mirena IUD

Were you on Mirena® at the time?
Yes
No

If no, how long were you off?

Was the Mirena removed under general anesthesia?
Yes
No
Was the Mirena removed via laparoscope(belly button) or removed vaginally?
Laparoscope
Vaginally
Was hospitalization or medical care required after using Mirena®?
Yes
No

Were you using Mirena® at the time of hospitalization?
Yes
No
When did this occur?