A Petition to the United States Congress


Date: ____________________



A petition To the United States Congress:

I, (Name)  _________________________________________am signing this petition to request the United States Congress to immediately take action to protect American consumers from the serious adverse drug reactions that are occurring from a class of antibiotics known as “Fluoroquinolones”. These serious adverse drug reactions often leave victims with long-term or permanent, crippling disabilities, and cause preventable deaths. 

A few of the better known antibiotics include; Ciprofloxacin - (Cipro), Levofloxacin - (Levaquin), Ofloxacin – (Floxin), Moxifloxacin – (Avelox), and Gatifloxacin –(Tequin).”  

The respective pharmaceutical manufacturers and the FDA have failed to adequately warn the American public of the inherent risks associated with the use of this class of antibiotics and as a result many of these reactions are occurring unnecessarily and should have never occurred. 

There are no known effective treatments or cures for a fluoroquinolones adverse drug reaction. 

I am signing this petition to formally request that Congress conduct an investigation and hold hearings to remedy this serious problem and to provide corrective action leading to proper warnings, proper prescribing and also research into effective treatment outcomes for a fluoroquinolones adverse drug reaction. 

I am respectfully requesting that the United States Congress immediately and fully investigate the misconduct of the respective pharmaceutical companies and the FDA and to implement a procedure for the victims of this misconduct to be compensated for the damages they have suffered not withstanding existing statutes of limitations.



Name:__________________________________ (Required)


Address:________________________________________________ (optional)


City:___________________ (optional) State: _______________ (optional)


Zip Code: _______________ (optional)


Telephone: (       )_________________________(optional)


Fax: (        )___________________________________(optional)


Email: _______________________________________(optional)


Congressional District__________________________________ (Required)

If you don't know your Congressional District, please visit http://www.house.gov/writerep/ You simply need to type in your zip code.  

I, (Name) __________________________took the Fluoroquinolone aka (Quinolone)

Drug(s) (Which Drug) _______________________________________________(Required)

to treat the medical condition of ________________________________________

on Date: ______________________

The Adverse Drug Reactions that happened to me is/are and started on date: ___________________________________________________________________




Sex: Male_____ Female_____ Age _______

As of today's date,__________________ , I am suffering from the following:








*If you need more space to write please attach extra pages.



Signed: _________________________________ Date: _______________________


Please mail to: 

P.O. Box 305
Glenview, IL 60025