We will accept cases that satisfy the criteria below:

1. Did you or your loved one have a port-a-cath implanted for the administration of medication, nutrition, or blood transfusions? Must be “Yes”
2. Was the “Port” implanted in your chest? Must be “Yes”
3. Description of ailment that required port-a-cath implantation:
   1. chemotherapy/cancer
   2. Crohn’s disease
   3. Sickle Cell
   4. rheumatoid arthritis medication
   5. blood transfusions
   6. parenteral nutrition
4. Do you know what type of catheter or port was implanted? (Below is a list of options that intake agent will have, however, in many instances the potential claimant will not be aware of the type of catheter that was implanted. In this instance, the answer of “unknown” would not be a disqualifying event)
   • BardPort
   • Bard PowerPort
   • Bard SlimPort
   • Bard MRI Ports
   • Bard Groshong© Catheter
   • Bard Titanium Low-Profile Port
   • Bard Vaccess CT
   • Bard X-Port ISP
   • Angiodynamics/Navilyst BioFlo Port
   • Angiodynamics/Navilyst SmartPort
   • Angiodynamics/Navilyst SmartPort CT
   • Angiodynamics/Navilyst Vaxcel
   • Angiodynamics/Navilyst Vortex
   • Angiodynamics/Navilyst Xcela
   • Other/Unknown

5. Date of implant: (claimant must have own records if implant occurred prior to 2010)

6. How long after implant was injury diagnosed: (disqualify if less than two month)

7. Physician who implanted the catheter / implanted port (name, address, phone)? (information only)
8. Did the catheter or implanted port: (disqualify if one of the following injuries did not occur
   • break
   • fracture
   • fracture with embolism
   • fractured pieces became embedded in artery/organ
   • fracture with pieces that broke apart and passed through the heart
   • infection
   • leakage at port site
   • migration of the ‘catheter’ (port migrations on the surface of the skin are fairly common and not a qualifying event, a migration of the catheter away from the port could be the result of degradation and fracture)
   • perforation of a vein or organ

9. Did you or your loved one experience any of the following complications? (Disqualify if one of the following complications did not occur)

• Blood clots
• Cardiac arrythmia or symptoms similar to heart attack
• Cardiac punctures
• Cardiac/pericardial tamponade
• Death
• Hematoma
• Hemorrhage
• Laceration to blood vessels
• Necrosis (dead tissue) of the tissue around the port
• Pulmonary embolism (PE)
• Severe and persistent pain around port/catheter

10. Date Injury was Diagnosed: (information only)

11. Diagnosing Physician & Facility Address: (information only)

12.What treatment did you receive for the injuries described above: (information only)

13.Date(s) of above-described treatment: (information only)

14.Treating Physician & Facility Address: (information only)

15. How long were you hospitalized for: (if infection, must be at least two days)

· Client cannot be represented by another attorney for this matter.