Complaint Against Eli Lilly and Company , Filed by Tania Lee. (Attachments: # 1 Civil Cover Sheet)(Warriner, C.)

,

as

of the estate of , deceased.

Novo Nordisk Inc. Novo Nordisk A/S Eli Lilly and Company Lilly USA, LLC other(s) (identify): IDENTIFICATION OF PARTIES

Plaintiff(s)

1.

Full (first, middle, and last) name of Plaintiff injured/deceased due to use of GLP- 1 RA Product(s): Eddie Banks

2.

If applicable, full name(s) and representative capacity of Plaintiff(s) alleging wrongful death claim:

,

as

of the estate of , deceased.

3.

If applicable, full name(s) of Plaintiff(s) alleging survival claims, as permitted under state law(s):

4.

If applicable, full name(s) of Plaintiff(s) alleging loss of consortium or loss of services: Kirk Banks Defendant(s)

5.

Plaintiff(s)/Decedent's Representative is/are suing the following Defendant(s) (check all that apply):

Novo Nordisk Inc. Novo Nordisk A/S Eli Lilly and Company Lilly USA, LLC other(s) (identify): IDENTIFICATION OF PARTIES

Plaintiff(s)

1.

Full (first, middle, and last) name of Plaintiff injured/deceased due to use of GLP- 1 RA Product(s): Eddie Banks

2.

If applicable, full name(s) and representative capacity of Plaintiff(s) alleging wrongful death claim:

,

as

of the estate of , deceased.

3.

If applicable, full name(s) of Plaintiff(s) alleging survival claims, as permitted under state law(s):

4.

If applicable, full name(s) of Plaintiff(s) alleging loss of consortium or loss of services: Kirk Banks Defendant(s)

5.

Plaintiff(s)/Decedent's Representative is/are suing the following Defendant(s) (check all that apply):

Novo Nordisk Inc. Novo Nordisk A/S Eli Lilly and Company Lilly USA, LLC other(s) (identify): Tania Lee N/A N/A

N/A

6.

City and state of Plaintiff(s)' current residence (or in a case brought on behalf of a Decedent, Decedent's last permanent residence): Mount Dora, Florida

7.

State where Plaintiff/Decedent was prescribed the GLP-1RA Product(s) at issue: Florida

8.

State of Plaintiff's/Decedent's residence at time of their use of the GLP-1RA Product(s) at issue: Florida

9.

City and state of Plaintiff(s)'/Decedent's residence at time of diagnosis of injury: 10.

Jurisdiction is based on:

diversity of citizenship pursuant to 28 U.S.C. § 1332 other (plead in sufficient detail as required by applicable rules):

11.

The District Court(s) where Plaintiff(s) might have otherwise filed this Short Form Complaint, absent this Court's CMO No. 14, and/or to where remand could be ordered: Middle District of Florida

6.

City and state of Plaintiff(s)' current residence (or in a case brought on behalf of a Decedent, Decedent's last permanent residence): Mount Dora, Florida

7.

State where Plaintiff/Decedent was prescribed the GLP-1RA Product(s) at issue: Florida

8.

State of Plaintiff's/Decedent's residence at time of their use of the GLP-1RA Product(s) at issue: Florida

9.

City and state of Plaintiff(s)'/Decedent's residence at time of diagnosis of injury: 10.

Jurisdiction is based on:

diversity of citizenship pursuant to 28 U.S.C. § 1332 other (plead in sufficient detail as required by applicable rules):

11.

The District Court(s) where Plaintiff(s) might have otherwise filed this Short Form Complaint, absent this Court's CMO No. 14, and/or to where remand could be ordered: Middle District of Florida Pompano Beach, Florida Florida Florida Lantana, Florida



Southern District of Florida

claims occurred there;

_______ other (plead in sufficient detail as required by applicable rules):

Venue is proper in the District Court identified in Paragraph 11 because:

a substantial part of the events and omissions giving rise to Plaintiff(s)' claims occurred there; other (plead in sufficient detail as required by applicable rules):

13.

If applicable, identify the citizenship of any additional Defendant(s) named above: 12.

Venue is proper in the District Court identified in Paragraph 11 because:

a substantial part of the events and omissions giving rise to Plaintiff(s)' claims occurred there; other (plead in sufficient detail as required by applicable rules):

13.

If applicable, identify the citizenship of any additional Defendant(s) named above:

Ozempic (semaglutide) Wegovy (semaglutide) Rybelsus (oral semaglutide) Saxenda (liraglutide) Trulicity (dulaglutide) Mounjaro (tirzepatide) Zepbound (tirzepatide) other(s) (identify):

14.

Plaintiff/Decedent used the following GLP-1 RA Product(s) for which claims are being asserted in this case (check all that apply):

Ozempic (semaglutide) Wegovy (semaglutide) Rybelsus (oral semaglutide) Saxenda (liraglutide) Trulicity (dulaglutide) Mounjaro (tirzepatide) Zepbound (tirzepatide) other(s) (identify):

15.

To the best of Plaintiff(s)' knowledge, Plaintiff/Decedent used GLP-1 RA Product(s) during the following approximate date range(s) (month(s) and year(s)) (if multiple products, specify date range(s) for each product): December 2020 to July 2023

14.

Plaintiff/Decedent used the following GLP-1 RA Product(s) for which claims are being asserted in this case (check all that apply):

Ozempic (semaglutide) Wegovy (semaglutide) Rybelsus (oral semaglutide) Saxenda (liraglutide) Trulicity (dulaglutide) Mounjaro (tirzepatide) Zepbound (tirzepatide) other(s) (identify):

15.

To the best of Plaintiff(s)' knowledge, Plaintiff/Decedent used GLP-1 RA Product(s) during the following approximate date range(s) (month(s) and year(s)) (if multiple products, specify date range(s) for each product): December 2020 to July 2023



10/06/2022 until 06/2024