<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-2025-971
Date of Submission: 2025-06-08

This report was submitted by a Pharmacist from Mercado Inc Medical Center concerning patient ANON-PX-5448. The subject is a 39-year-old female with a significant medical history including coronary artery disease, asthma, 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): Warfarin (Anticoagulant) administered via the Intravenous route at a dosage of 71mg, initiated on 2025-05-07 for Thromboembolism prevention with the course ongoing; Lisinopril (ACE inhibitor) administered via the Intramuscular route at a dosage of 307mg, initiated on 2025-05-07 for Hypertension with the course ongoing.

On approximately 2025-05-26, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Anaphylaxis, Diarrhea, Nausea, Hepatotoxicity. The Pruritus was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Anaphylaxis was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed list and advised rest. The current patient status regarding this symptom is 'Unknown'. The Diarrhea was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovering'. The Nausea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Hepatotoxicity was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed always and advised arm. The current patient status regarding this symptom is 'Unknown'. 

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. 

Reporter's Narrative Summary: Within position policy. Ground often three book college despite now dinner. Force red she conference statement majority.</data>
report_id: ADR-2025-971
report_date: '2025-06-08'
patient_details:
  patient_id: ANON-PX-5448
  gender: Female
  relevant_history:
  - coronary artery disease
  - asthma
  - osteoarthritis
  age_at_reaction: 39
suspected_drugs:
- drug_name: Warfarin
  dosage: 71mg
  route_of_administration: Intravenous
  start_date: '2025-05-07'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
- drug_name: Lisinopril
  dosage: 307mg
  route_of_administration: Intramuscular
  start_date: '2025-05-07'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2025-05-26'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2025-05-26'
  severity: Life-threatening
  outcome: Unknown
  intervention_required: true
  intervention_details: Prescribed list and advised rest.
- symptom_name: Diarrhea
  onset_date: '2025-05-26'
  severity: Mild
  outcome: Recovering
  intervention_required: true
- symptom_name: Nausea
  onset_date: '2025-05-26'
  severity: Life-threatening
  outcome: Unknown
  intervention_required: false
- symptom_name: Hepatotoxicity
  onset_date: '2025-05-26'
  severity: Life-threatening
  outcome: Unknown
  intervention_required: true
  intervention_details: Prescribed always and advised arm.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Mercado Inc Medical Center
reporter_type: Pharmacist
notes: Within position policy. Ground often three book college despite now dinner.
  Force red she conference statement majority.
