Elmiron Follow-Up Qs

1. Do you already have an attorney or have you already received a settlement from an Elmiron case?
2. Have you used the medication, Elmiron? If yes, why was it prescribed?
3. Since using Elmiron, have you experienced any of the following symptoms with your vision?
   1. Seeing Straight Lines as Wavy/Bending
   2. Difficulty Driving at Night
   3. Central Vision Loss
   4. Muted or Faded Colors
   5. Blurred Vision
   6. Difficulty Reading
   7. Distorted Vision
   8. Eye Pain
   9. Flashes or Floaters
   10. None of These.
4. Were you medically diagnosed with any of the following?
   1. Pigmentary Maculopathy
   2. Pigmentary Macular Degeneration
   3. Pigmentation Maculitis
   4. Retinal maculopathy
   5. Age Related, Wet, or Dry Macular Degeneration
   6. None of these
5. When were you diagnosed with the complications you listed?
6. When did you start taking Elmiron?
7. Are you still taking Elmiron? If no, when did you stop?
8. Please provide the name and address of the pharmacy where your Elmiron prescription was/is filled.
9. Please provide the name of doctor or medical facility that prescribed Elmiron.
10. Please provide the name and address of the doctor or medical facility who diagnosed your vision problems.
11. Please provide the date of birth of the injured party
12. Please provide your physical mailing address (your potential claim cannot be evaluated without your mailing address).
13. Please provide any additional information which may be helpful to your potential case.