Last Step! Congratulations! We want to thank you for taking the time to fill out your Blood Thinner contract. In order for us to move forward with your case, please fill out the following: Full Name(required) Phone Number(required) Email Address(required) What years did you take Xarelto or Pradaxa?(required) What Pharmacy did you use?(required) What type of injury/symptoms occurred? Internal Bleed Uncontrollable Bleeding Excessive nose bleeds Excessive menstrual bleeding Gastrointestinal Bleed Cerebral hemorrhage Other Bleed Event What Hospital treated you for your injury? What year did you suffer your injury? Additional Information Submit