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 - VERSION 2

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 

Amended Master Personal Injury Complaint (“AMPIC”) in In re: Zantac (Ranitidine) 

Products Lability Litigation, MDL No. 2924 (S.D. Fla). Plaintiff(s) file(s) this Short-Form 

Complaint - Version 2 as permitted by Pretrial Order No. 31 and as modified by the Court's 

Orders regarding motions to dismiss [DE 2532, 2512, 2513, 2515, and 2016]. 

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

Lynn Perkins

Lynn Perkins ✘

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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 Amended Master 

Personal Injury Complaint in this action:

a. Brand-Name Manufacturers: 

2

Puta Gorda FL

Pfizer Inc.; Boehringer Ingelheim USA Corporation; GlaxoSmithKline LLC;

GlaxoSmithKline (America) Inc.; Boehringer Ingelheim Pharmaceuticals, Inc.;

Boehringer Ingelheim International GmbH; Patheon Manufacturing Service LLC;

Boehringer Ingelheim Promeco, S.A. de C.V.; Boehringer Ingelheim Corporation;

GlaxoSmithKline PLC; Catalytica Pharmaceutical Inc.; DSM Pharmaceuticals

Inc.;Sanofi

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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: ______________________

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 

Amended Master Personal Injury Complaint. 

9

/s/ Brett A. Emison Brett A. Emison Langdon & Emison, LLC 911 Main Street P.O. Box 220 Lexington MO 64067 brett@lelaw.com 660-259-7199

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