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Date of birth of person injured (mm-dd-yyyy):
Date you stopped taking the drug (mm-yyyy):
Date you started taking the drug (mm-yyyy):
What condition was this medication prescribed to treat?
Weight before taking Meridia:
Weight after taking Meridia:
Did you experience high blood pressure before taking Meridia?YesNo
Was blood pressure monitored while taking Meridia?YesNo
Were any of the following problems experienced while taking Meridia?Heart DiseaseHeart FailureStrokeSeizuresDilated CardiomyopathyAddiction
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