Lupron Petition

Welcome! This is the web-page for people who have taken Lupron and incurred medical problems after taking the drug. If you would like to participate in a voluntary petition to the FDA please fill in the below requested information and click on the "Send Survey" button. Include your e-mail address if you have one for future contact.  Please do not include personal comments or questions on your petition form as this information will be sent exactly as submitted. The petitions will be sent to the U.S. Senate's office and forwarded to the FDA requesting a review of the drug. Thank you for your participation.

Name:

Street Address:

City:

State:  Zip Code:

Phone Number:

Email:

Short Term Side-Effects:


Dates Taken:


Permanent Symptoms or Diagnosis:


Are you having difficulty obtaining medical treatment, getting tests performed, or receiving a diagnosis, etc. since your use of Lupron?

If yes, explain.



 

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