<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-2025-159
Date of Submission: 2025-07-26

This report was submitted by a Patient from Young, Paul and Mann Medical Center concerning patient ANON-PX-3893. The subject is an adult male with a significant medical history including hypertension, osteoarthritis. 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 Subcutaneous route at a dosage of 105mg, initiated on 2025-07-01 for Hypothyroidism and discontinued on 2025-07-13.

On approximately 2025-07-11, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Hepatotoxicity, Stevens-Johnson syndrome, Dizziness, Maculopapular Rash. The Hepatotoxicity was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Stevens-Johnson syndrome was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Dizziness was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Maculopapular Rash was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed yet and advised feel. The current patient status regarding this symptom is 'Fatal'. 

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

</data>
report_id: ADR-2025-159
report_date: '2025-07-26'
patient_details:
  patient_id: ANON-PX-3893
  gender: Male
  relevant_history:
  - hypertension
  - osteoarthritis
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 105mg
  route_of_administration: Subcutaneous
  start_date: '2025-07-01'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-07-13'
adverse_reactions:
- symptom_name: Hepatotoxicity
  onset_date: '2025-07-11'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-07-11'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Dizziness
  onset_date: '2025-07-11'
  severity: Mild
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Maculopapular Rash
  onset_date: '2025-07-11'
  severity: Severe
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed yet and advised feel.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Young, Paul and Mann Medical Center
reporter_type: Patient
