<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-2025-258
Date of Submission: 2025-07-18

This report was submitted by a Patient from Fletcher LLC Medical Center concerning patient ANON-PX-4282. The subject is an adult female with a significant medical history including asthma, anxiety, hypertension. 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): Metformin administered via the Subcutaneous route at a dosage of 59mg, initiated on 2025-05-17 for Type 2 diabetes and discontinued on 2025-07-12.

On approximately 2025-06-07, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Nausea. The Vomiting was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed per and advised expect. The current patient status regarding this symptom is 'Not Recovered'. The Nausea was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed newspaper and advised job. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 1 was calculated, The assessment concluded the relationship was 'Possible'. Dechallenge/Rechallenge status was noted as: 'Positive rechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Sell foot traditional heart.</data>
report_id: ADR-2025-258
report_date: '2025-07-18'
patient_details:
  patient_id: ANON-PX-4282
  gender: Female
  relevant_history:
  - asthma
  - anxiety
  - hypertension
suspected_drugs:
- drug_name: Metformin
  dosage: 59mg
  route_of_administration: Subcutaneous
  start_date: '2025-05-17'
  indication_for_use: Type 2 diabetes
  end_date: '2025-07-12'
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2025-06-07'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed per and advised expect.
- symptom_name: Nausea
  onset_date: '2025-06-07'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed newspaper and advised job.
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 1
reporting_facility: Fletcher LLC Medical Center
reporter_type: Patient
notes: Sell foot traditional heart.
