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Have you bought cough or cold medicine to administer to a child under the age of 6? Tell us about it!

In order to proceed with the class action suit against manufacturers of cough and cold medicines filed in March 2009, we are looking for Quebec residents who bought a cough or cold medicine to give to a child under 6 years of age.

If you belong to this group, please take a few minutes to answer this questionnaire. The information you provide us with will help our lawyers in their work and may be used in court.

To learn more about the history of this class action suit, send us your email address or consult our Website and the newspapers.

None of these fields is mandatory:
First name

Family name


Email

Telephone Number
 


Have you purchased one or more of the following brands (syrup, tablets, drops, etc.) and administered it/them to a child under 6 years of age?

Brands :                   
 
Advil Biomédic
(Famili-Prix)
   
Balminil    

  Equate
(Walmart)
Benylin
       
Buckley's
 Exact
(Loblaws)
   
Dimetapp    
    Life Brand
(Pharmaprix)
Robitussin
       
Sudafed Option
(Uniprix)
   
Triaminic
    
    Personnelle
(Jean Coutu)
Tylenol
       
Vick's Sélection
(Métro)
 

 

Other brands:



Please describe each product for which you have kept at least one proof of purchase (receipt, packaging or container) and specify the age of the child for whom it was intended at the time of purchase.
Product brand and name, DIN no., therapeutic class, dosage, etc.

Product 1
 
Brand  (e. g.: Triaminic, Dimetapp, etc. )
Name  (e.g .: Nighttime Cough, Cold and Cough for Children, etc.)
DIN no  (often located at the bottom of the package)
Therapeutic classification
(antihistamine, antitussif, expectorant, decongestant)

Dosage
Does the dosage suggest that the medicine can be given to children:
younger than 2 ?
   YES NO
from 2 to 6 ?   YES NO

Other details :
Age of child at the time you administered the product:
Under 2                        Between 2 and 6 -1 day

Proof of purchase retained:
Receipt:   YES NO
Packaging :   YES NO
Container :
  YES NO

If you have retained proof of purchase for several products, please fill in the following fields before submitting your answers.

If you have retained proof of purchase for only one product, we thank you for answering this questionnaire and ask you to submit your answers now






Other products for which you have retained proof of purchase:
Product 2
 
Brand (e. g.: Triaminic, Dimetapp, etc)
Name (e.g .: Nighttime Cough, Cold and Cough for Children, etc.)
DIN no (often located at the bottom of the package)
Therapeutic classification
(antihistamine, antitussif, expectorant, decongestant)

Dosage
Does the dosage suggest that the medicine can be given to children:
younger than 2 ?
   YES NO
from 2 to 6 ?   YES NO

Other details
Age of child at the time you administered the product:
Under 2                         Between 2 and 6 -1 day

Proof of purchase retained:
Reciept :   YES NO
Packaging :   YES NO
Container :
  YES NO


If you have retained proof of purchase for a third product, please fill in the following fields before submitting your answers.

If you have retained proof of purchase for only two products, we thank you for answering this questionnaire and ask you to submit your answers now.






Other products for which you have retained proof of purchase:
Product 3
 
Brand (e. g.: Triaminic, Dimetapp, etc)
Name (e.g .: Nighttime Cough, Cold and Cough for Children, etc.)
DIN no (often located at the bottom of the package)
Therapeutic classification
(antihistamine, antitussif, expectorant, decongestant)

Dosage
Does the dosage suggest that the medicine can be given to children:
younger than 2 ?
   YES NO
from 2 to 6  ?   YES NO

Other details :
Age of child at the time you administered the product:
Under 2                         Between 2 and 6 -1 day

Proof of purchase retained:
Receipt :   YES NO
Packaging :   YES NO
Container :
  YES NO

If you have retained proof of purchase for three products, please submit your answers now.

 
Thank you for completing this questionnaire
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