UNITED STATES DISTRICT COURT

NORTHERN DISTRICT OF FLORIDA

PENSACOLA DIVISION

IN RE: 3M COMBAT ARMS

EARPLUG PRODUCTS

LIABILITY LITIGATION

This Document Relates to:

________________________

PLAINTIFF(S),

v.

3M COMPANY, 3M 

OCCUPATIONAL SAFETY LLC, 

AEARO HOLDING LLC, AEARO 

INTERMEDIATE LLC, AEARO LLC, 

and AEARO TECHNOLOGIES LLC, 

DEFENDANTS.

Case No. 3:19-md-2885

Judge M. Casey Rodgers

Magistrate Judge Gary R. Jones

MASTER SHORT FORM 

COMPLAINT AND

JURY TRIAL DEMAND

Civil Action No.: ________________

MASTER SHORT FORM COMPLAINT AND JURY TRIAL DEMAND

Plaintiff(s) incorporate(s) by reference the Master Long Form Complaint and 

Jury Trial Demand filed in In re: 3M Combat Arms Earplug Products Liability 

Litigation on September 20, 2019. Pursuant to Pretrial Order No. ______, this Short 

Form Complaint adopts the allegations, claims, and requested relief as set forth in 

the Master Long Form Complaint. As necessary herein, Plaintiff(s) may include:

(a) additional claims and allegations against Defendants, as set forth in Paragraphs

10 and 11 or an additional sheet attached hereto; and/or (b) additional claims and

1

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allegations against other Defendants not listed in the Master Long Form Complaint, 

as set forth in Paragraphs 12 and 13 or an additional sheet attached hereto. 

Plaintiff(s) further allege(s) as follows:

I. DEFENDANTS

1. Plaintiff(s) name(s) the following Defendants in this action:

3M Company 

3M Occupational Safety LLC 

Aearo Holding LLC

Aearo Intermediate LLC

Aearo LLC

Aearo Technologies LLC 

II. PLAINTIFF(S)

2. Name of Plaintiff:

3. Name of spouse of Plaintiff (if applicable to loss of consortium

claim):

4. Name and capacity (i.e., executor, administrator, guardian, conservator,

etc.) of other Plaintiff, if any:

_________________________________________________

First Middle Last

2

✔

✔

✔

✔

✔

✔

Khattabi M Vanlerberg

Case 8:20-cv-12621-MCR-GRJ Document 1 Filed 06/02/20 Page 2 of 6
5. State(s) of residence of Plaintiff(s):

III. JURISDICTION

6. Basis for jurisdiction (diversity of citizenship or other):

7. Designated forum (United States District Court and Division) in which

venue would be proper absent direct filing:

IV. USE OF DUAL-ENDED COMBAT ARMS EARPLUG

8. Plaintiff used the Dual-Ended Combat Arms Earplug:

Yes 

No

V. INJURIES

9. Plaintiff alleges the following injuries and/or side effects as a result of

using the Dual-Ended Combat Arms Earplug:

Hearing loss

Sequelae to hearing loss

Other [specify below]

3

CAdiversity of citizenship

✔

✔

✔

✔

Tinnitus or other hearing damage, including a loss of normal hearing function

not clinically defined as hearing loss.

Case 8:20-cv-12621-MCR-GRJ Document 1 Filed 06/02/20 Page 3 of 6
VI. CAUSES OF ACTION

10. Plaintiff(s) adopt(s) in this Short Form Complaint the following claims

asserted in the Master Long Form Complaint and Jury Trial Demand,

and the allegations with regard thereto as set forth in the Master Long

Form Complaint and Jury Trial Demand:

Count I – Design Defect – Negligence 

Count II – Design Defect – Strict Liability 

Count III – Failure to Warn – Negligence 

Count IV – Failure to Warn – Strict Liability 

Count V – Breach of Express Warranty 

Count VI – Breach of Implied Warranty 

Count VII – Negligent Misrepresentation 

Count VIII – Fraudulent Misrepresentation 

Count IX – Fraudulent Concealment 

Count X – Fraud and Deceit 

Count XI – Gross Negligence 

Count XII – Negligence Per Se 

Count XIII – Consumer Fraud and/or Unfair Trade 

Practices Count XIV – Loss of Consortium 

Count XV – Unjust Enrichment 

Count XVI – Punitive Damages 

4

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

✔

Case 8:20-cv-12621-MCR-GRJ Document 1 Filed 06/02/20 Page 4 of 6
Count XVII – Other [specify below]

11. If additional claims against the Defendants identified in the Master

Long Form Complaint and Jury Trial Demand are alleged in Paragraph

10, the facts supporting these allegations must be pleaded. Plaintiff(s)

assert(s) the following factual allegations against the Defendants

identified in the Master Long Form Complaint and Jury Trial Demand:

12. Plaintiff(s) contend(s) that additional parties may be liable or

responsible for Plaintiff(s)’ damages alleged herein. Such additional

parties, who will be hereafter referred to as Defendants, are as follows

(must name each Defendant and its citizenship):

5

Case 8:20-cv-12621-MCR-GRJ Document 1 Filed 06/02/20 Page 5 of 6
13. Plaintiff(s) assert(s) the following additional claims and factual

allegations against other Defendants named in Paragraph 12:

WHEREFORE, Plaintiff(s) pray(s) for relief and judgment against 

Defendants and all such further relief that this Court deems equitable and just as set 

forth in the Master Long Form Complaint and Jury Demand and any additional relief 

to which Plaintiff(s) may be entitled. 

Dated: ______________

6

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