UNITED STATES DISTRICT COURT

SOUTHERN DISTRICT OF FLORIDA

 MDL NO 2924 

20-MD-2924

 JUDGE ROBIN L ROSENBERG

 MAGISTRATE JUDGE BRUCE REINHART

JURY TRIAL DEMANDED

IN RE: ZANTAC (RANITIDINE)

PRODUCTS LIABILITY

LITIGATION

__________________________________/ 

THIS DOCUMENT RELATES TO: 

__________________________________

(Plaintiff Name(s)) 

SHORT-FORM COMPLAINT

The Plaintiff(s) named below, by counsel, file(s) this Short Form Complaint against 

Defendants named below. Plaintiff(s) incorporate(s) by reference the allegations contained in the 

Master Personal Injury Complaint (“MPIC”) in In re: Zantac (Ranitidine) Products Lability 

Litigation, MDL No. 2924 (S.D. Fla). Plaintiff(s) file(s) this Short-Form Complaint as permitted 

by Pretrial Order No. 31. 

Plaintiff(s) select(s) and indicate(s) by completing where requested, the Parties and Causes 

of Actions specific to this case. Where certain claims require additional pleading or case specific 

facts and individual information, Plaintiff(s) shall add and include them herein. 

Plaintiff(s), by counsel, allege as follows: 

I. PARTIES, JURISDICTION, AND VENUE

A. PLAINTIFF(S)

1. Plaintiff(s) _________________________________________________________

(“Plaintiff(s)”) brings this action (check the applicable designation):

On behalf of [himself/herself];

1

Christine Beculheimer, Anticipated Representative and Heir to the Estate of 

Arlene Wise

Christine Beculheimer, Anticipated

Representative and Heir to the Estate of

Arlene Wise

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In representative capacity as the __________________, on behalf 

of the injured party, (Injured Party’s Name) 

___________________.

2. Injured Party is currently a resident and citizen of (City, State)

_________________________ and claims damages as set forth below.

—OR— 

Decedent died on (Month, Day, Year) ____________________. At the time of 

Decedent’s death, Decedent was a resident and citizen of (City, State) 

_________________________. 

If any party claims loss of consortium, 

3. _________________ (“Consortium Plaintiff”) alleges damages for loss of

consortium.

4. At the time of the filing of this Short Form Complaint, Consortium Plaintiff is a

citizen and resident of (City, State) _________________________.

5. At the time the alleged injury occurred, Consortium Plaintiff resided in (City, State)

_________________________.

B. DEFENDANT(S)

6. Plaintiff(s) name(s) the following Defendants from the Master Personal Injury

Complaint in this action:

a. Brand Manufacturers:

2

Sanofi S.A.; GlaxoSmithKline LLC; Boehringer Ingelheim Pharmaceuticals, Inc.;

Sanofi-Aventis U.S. LLC; Patheon Manufacturing Service LLC; Sanofi US Services

Inc.

✘

Arlene Wise Jul 2 2020 Troy OH

Anticipated Representative 

and Heir to the Estate

; and John Doe

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b. Generic Manufacturers:

c. Distributors:

d. Retailers:

e. Repackagers:

f. Others Not Named in the MPIC:

3

Chattem, Inc.

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C. JURISDICTION AND VENUE

7. Identify the Federal District Court in which Plaintiff(s) would have filed this action

in the absence of Pretrial Order No. 11 (direct filing) [or, if applicable, the District

Court to which their original action was removed]:

______________ District of _______

8. Jurisdiction is proper upon diversity of citizenship.

II. PRODUCT USE

9. The Injured Party used Zantac and/or generic ranitidine: [Check all that apply]

By prescription 

Over the counter 

10. The Injured Party used Zantac and/or generic ranitidine from approximately

(month, year) _______________ to _______________.

III. PHYSICAL INJURY

11. As a result of the Injured Party’s use of the medications specified above, [he/she]

was diagnosed with the following specific type of cancer (check all that apply):

Check all 

that 

apply 

Cancer Type Approximate Date of 

Diagnosis 

BLADDER CANCER

BRAIN CANCER

BREAST CANCER

COLORECTAL CANCER

4

Southern OH ✘

✘

Jan 1989 Jan 2017

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12. Defendants, by their actions or inactions, proximately caused the injuries to

Plaintiff(s)

Check all 

that 

apply 

Cancer Type Approximate Date of 

Diagnosis 

ESOPHAGEAL/THROAT/NASAL CANCER

INTESTINAL CANCER

KIDNEY CANCER 

LIVER CANCER

LUNG CANCER

OVARIAN CANCER

PANCREATIC CANCER

PROSTATE CANCER

STOMACH CANCER

TESTICULAR CANCER

THYROID CANCER

UTERINE CANCER

OTHER CANCER: 

DEATH (CAUSED BY CANCER)

5

✘ Sep 1 2017 ✘ Sep 1 2017 ✘ Sep 1 2017 ✘ Jul 2 2020

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13. The following Causes of Action asserted in the Master Personal Injury Complaint

are asserted against the specified defendants in each class of Defendants

enumerated therein, and the allegations with regard thereto are adopted in this Short

Form Complaint by reference.

Check if 

Applicable

COUNT Cause of Action 

I STRICT PRODUCTS LIABILITY – FAILURE TO WARN 

II STRICT PRODUCTS LIABILITY – DESIGN DEFECT

III STRICT PRODUCTS LIABILITY – MANUFACTURING 

DEFECT

IV NEGLIGENCE – FAILURE TO WARN

V NEGLIGENT PRODUCT DESIGN 

VI NEGLIGENT MANUFACTURING 

VII GENERAL NEGLIGENCE 

VIII NEGLIGENT MISREPRESENTATION 

IX BREACH OF EXPRESS WARRANTIES

X BREACH OF IMPLIED WARRANTIES

XI

VIOLATION OF CONSUMER PROTECTION AND 

DECEPTIVE TRADE PRACTICES LAWS and specify the state’s 

statute below: 

_____________________________________________________

XII UNJUST ENRICHMENT

XIII LOSS OF CONSORTIUM

XIV SURVIVAL ACTION

XV WRONGFUL DEATH

XVI OTHER: _______________________________________________ 

XVII OTHER: _______________________________________________ 

IV. CAUSES OF ACTION ASSERTED

XVIII OTHER: _______________________________________________ 

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If Count XVI, Count XVII or Count XVIII is alleged, additional facts supporting the 

claim(s):

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V. JURY DEMAND

14. Plaintiff(s) hereby demand(s) a trial by jury as to all claims in this action.

VI. PRAYER FOR RELIEF

WHEREFORE, Plaintiff(s) has/have been damaged as a result of Defendants’ actions or

inactions and demand(s) judgment against Defendants on each of the above-referenced causes of

action, jointly and severally to the full extent available in law or equity, as requested in the Master

Personal Injury Complaint. 

Attorney 1 Signature:__________________________

Attorney 1 Print:______________________________

Attorney 2 Signature:__________________________

Attorney 2 Print:______________________________

Firm: ______________________________________

Address 1: __________________________________

Address 2: __________________________________

City: ____________________________

State: ___________________________

Zip: _____________

Email: _____________________________________

Phone: ______________________

Attorney 1 Signature:__________________________

Attorney 1 Print:______________________________

Attorney 2 Signature:__________________________

Attorney 2 Print:______________________________

Firm: ______________________________________

Address 1: __________________________________

Address 2: __________________________________

City: ____________________________

State: ___________________________

Zip: _____________

Email: _____________________________________

Phone: ______________________

8

/s/ Daniel A. Nigh /s/ Madeline E. Pendley Daniel A. Nigh Madeline E. Pendley Levin, Papantonio, Rafferty Law Firm Levin, Papantonio, Rafferty Law Firm 316 S. Baylen Street, Suite 600 316 S. Baylen Street, Suite 600 Pensacola Pensacola FL FL 32502 32502 dnigh@levinlaw.com mpendley@levinlaw.com (850) 435-7013 (850) 435-7002

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