<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-2025-716
Date of Submission: 2025-07-08

This report was submitted by a Physician from Mercer, Harrell and Vega Medical Center concerning patient ANON-PX-7881. The subject is a 84-year-old other with a significant medical history including chronic kidney disease, asthma, atrial fibrillation, seasonal allergies. 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 (Thyroid hormone) administered via the Intravenous route at a dosage of 415mg, initiated on 2025-04-26 for Hypothyroidism and discontinued on 2025-06-04; Lisinopril (ACE inhibitor) administered via the Topical route at a dosage of 140mg, initiated on 2025-04-26 for Hypertension and discontinued on 2025-06-04.

On approximately 2025-05-20, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Maculopapular Rash, Somnolence, Diarrhea, Headache. The Pruritus was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed instead and advised personal. The current patient status regarding this symptom is 'Unknown'. The Maculopapular Rash was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovered'. The Somnolence was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Headache was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 9 was calculated, The assessment concluded the relationship was 'Highly Probable'. Dechallenge/Rechallenge status was noted as: 'Rechallenge not performed'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Spend through edge stay list. All fine party church member parent. Morning religious wife.</data>
report_id: ADR-2025-716
report_date: '2025-07-08'
patient_details:
  patient_id: ANON-PX-7881
  gender: Other
  relevant_history:
  - chronic kidney disease
  - asthma
  - atrial fibrillation
  - seasonal allergies
  age_at_reaction: 84
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 415mg
  route_of_administration: Intravenous
  start_date: '2025-04-26'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-06-04'
- drug_name: Lisinopril
  dosage: 140mg
  route_of_administration: Topical
  start_date: '2025-04-26'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2025-06-04'
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2025-05-20'
  severity: Moderate
  outcome: Unknown
  intervention_required: true
  intervention_details: Prescribed instead and advised personal.
- symptom_name: Maculopapular Rash
  onset_date: '2025-05-20'
  severity: Mild
  outcome: Recovered
  intervention_required: true
- symptom_name: Somnolence
  onset_date: '2025-05-20'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-05-20'
  severity: Mild
  outcome: Recovered
  intervention_required: false
- symptom_name: Headache
  onset_date: '2025-05-20'
  severity: Severe
  outcome: Recovered
  intervention_required: false
causality_assessment:
  assessment_conclusion: Highly Probable
  dechallenge_rechallenge: Rechallenge not performed
  naranjo_score: 9
reporting_facility: Mercer, Harrell and Vega Medical Center
reporter_type: Physician
notes: Spend through edge stay list. All fine party church member parent. Morning
  religious wife.
