<format type="yaml">{report_id: string, report_date: date, patient_details: {patient_id: string, age_at_reaction: number optional, gender: string, relevant_history: list[string]}, suspected_drugs: list[{drug_name: string, drug_class: string optional, dosage: string, route_of_administration: string, start_date: date, end_date: date optional, indication_for_use: string}], adverse_reactions: list[{symptom_name: string, onset_date: date, severity: string, outcome: string, intervention_required: boolean, intervention_details: string optional}], causality_assessment: {naranjo_score: number optional, assessment_conclusion: string, dechallenge_rechallenge: string}, reporting_facility: string, reporter_type: string, notes: string optional}</format> <data>PHARMACOVIGILANCE CASE REPORT - CONFIDENTIAL
Report Identifier: ADR-2025-699
Date of Submission: 2025-02-27

This report was submitted by a Physician from Simpson, Reyes and Lee Medical Center concerning patient ANON-PX-6052. The subject is a 33-year-old female with a significant medical history including chronic kidney disease, hypertension, asthma. The facility's standard operating procedure for ADR reporting was followed, and all patient data has been anonymized. The patient chart was reviewed for comorbidities. 

Current medication review revealed the following suspected agent(s): Levothyroxine administered via the Subcutaneous route at a dosage of 38mg, initiated on 2024-12-21 for Hypothyroidism with the course ongoing.

On approximately 2025-02-18, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Hepatotoxicity, Headache, Somnolence, Dizziness. The Vomiting was classified as Moderate in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Unknown'. The Hepatotoxicity was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed natural and advised page. The current patient status regarding this symptom is 'Recovering'. The Headache was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed avoid and advised among. The current patient status regarding this symptom is 'Fatal'. The Somnolence was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Dizziness was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 3 was calculated, The assessment concluded the relationship was 'Possible'. Dechallenge/Rechallenge status was noted as: 'Negative dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Like people civil blue pressure billion. Hundred whole military blood nature. Gun contain they action guy around.</data>
report_id: ADR-2025-699
report_date: '2025-02-27'
patient_details:
  patient_id: ANON-PX-6052
  gender: Female
  relevant_history:
  - chronic kidney disease
  - hypertension
  - asthma
  age_at_reaction: 33
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 38mg
  route_of_administration: Subcutaneous
  start_date: '2024-12-21'
  indication_for_use: Hypothyroidism
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2025-02-18'
  severity: Moderate
  outcome: Unknown
  intervention_required: true
- symptom_name: Hepatotoxicity
  onset_date: '2025-02-18'
  severity: Moderate
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed natural and advised page.
- symptom_name: Headache
  onset_date: '2025-02-18'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed avoid and advised among.
- symptom_name: Somnolence
  onset_date: '2025-02-18'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Dizziness
  onset_date: '2025-02-18'
  severity: Severe
  outcome: Fatal
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 3
reporting_facility: Simpson, Reyes and Lee Medical Center
reporter_type: Physician
notes: Like people civil blue pressure billion. Hundred whole military blood nature.
  Gun contain they action guy around.
