IN THE UNITED STATES DISTRICT COURT



IN THE UNITED STATES DISTRICT COURTFOR THE SOUTHERN DISTRICT OF WEST VIRGINIACHARLESTON DIVISIONIn Re: American Medical Systems, Inc., Pelvic Repair System Products Liability LitigationMDL No. 2325 Civil Action No. __________________________________________________________________________________________SHORT FORM COMPLAINTCome now the Plaintiff(s) named below, and for their Complaint against the Defendants named below, incorporate The First Amended Master Complaint in MDL No. 2325 by reference. Plaintiff(s) further show the court as follows:Female Plaintiff ___________________________Plaintiff Spouse___________________________Other Plaintiff and capacity (i.e., administrator, executor, guardian, conservator)___________________________State of Residence___________________________District Court and Division in which venue would be proper absent direct filing____________________________________________________________________________________________________________________Defendants (Check Defendants against whom Complaint is made): FORMCHECKBOX A. American Medical Systems, Inc. (“AMS”) FORMCHECKBOX B. Ethicon, Inc. FORMCHECKBOX C. Johnson & Johnson FORMCHECKBOX D. Boston Scientific Corporation FORMCHECKBOX E. C. R. Bard, Inc. (“Bard”) FORMCHECKBOX F. Sofradim Production SAS (“Sofradim”) FORMCHECKBOX G. Tissue Science Laboratories Limited (“TSL”) FORMCHECKBOX H. Mentor Worldwide LLC FORMCHECKBOX I. Coloplast Corp. FORMCHECKBOX J. Cook Incorporated FORMCHECKBOX K. Cook Biotech, Inc. FORMCHECKBOX L. Cook Medical, Inc. FORMCHECKBOX M. Desarrollo e Investigación Médica Aragonesa, S.L. (“DIMA”) FORMCHECKBOX N. Neomedic International, S.L. FORMCHECKBOX O. Neomedic Inc. FORMCHECKBOX P. Specialties Remeex International, S.L.Basis of Jurisdiction FORMCHECKBOX Diversity of Citizenship FORMCHECKBOX Other:________________A. Paragraphs in Master Complaint upon which venue and jurisdiction lie:_________________________________________________________________________________B. Other allegations of jurisdiction and venue________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Defendants’ products implanted in Plaintiff (Check products implanted in Plaintiff) FORMCHECKBOX A. Apogee; FORMCHECKBOX B. Perigee; FORMCHECKBOX C. MiniArc Sling; FORMCHECKBOX D. Monarc Subfascial Hammock; FORMCHECKBOX E. SPARC; FORMCHECKBOX F. In-Fast; FORMCHECKBOX G. BioArc; FORMCHECKBOX H. Elevate; FORMCHECKBOX I. Straight-In; FORMCHECKBOX J. Other____________________________________________________________________________________Defendants’ Products about which Plaintiff is making a claim. (Check applicable products) FORMCHECKBOX A. Apogee; FORMCHECKBOX B. Perigee; FORMCHECKBOX C. MiniArc Sling; FORMCHECKBOX D. Monarc Subfascial Hammock; FORMCHECKBOX E. SPARC; FORMCHECKBOX F. In-Fast; FORMCHECKBOX G. BioArc; FORMCHECKBOX H. Elevate; FORMCHECKBOX I. Straight-In; FORMCHECKBOX J. Other;__________________________________________________Date of Implantation as to Each Product________________________________________________________________ ________________________________Hospital(s) where Plaintiff was implanted (including City and State)____________________________________________________________________Implanting Surgeon(s)______________________________________________________________________Counts in the Master Complaint brought by Plaintiff(s) FORMCHECKBOX Count I - Negligence FORMCHECKBOX Count II – Strict Liability – Design Defect FORMCHECKBOX Count III – Strict Liability – Manufacturing Defect FORMCHECKBOX Count IV – Strict Liability – Failure to Warn FORMCHECKBOX Count V - Strict Liability – Defective Product FORMCHECKBOX Count VI - Breach of Express Warranty FORMCHECKBOX Count VII – Breach of Implied Warranty FORMCHECKBOX Count VIII – Fraudulent Concealment FORMCHECKBOX Count IX – Constructive Fraud FORMCHECKBOX Count X - Discovery Rule, Tolling and Fraudulent Concealment FORMCHECKBOX Count XI – Negligent Misrepresentation FORMCHECKBOX Count XII – Negligent Infliction of Emotional Distress FORMCHECKBOX Count XIII – Violation of Consumer Protection Laws FORMCHECKBOX Count XIV – Gross Negligence FORMCHECKBOX Count XV - Unjust Enrichment FORMCHECKBOX Count XVI - (By the Spouse) – Loss of Consortium FORMCHECKBOX Count XVII – Punitive Damages FORMCHECKBOX Other __________________ (please state the facts supporting this Count in the space, immediately below) FORMCHECKBOX Other __________________(please state the facts supporting this Count in the space, immediately below) ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________s/Attorney(s) for PlaintiffAddress, phone number, email address and bar information: ................
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