<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-2025-442
Date of Submission: 2025-06-29

This report was submitted by a Nurse from Sandoval, Lawson and Reed Medical Center concerning patient ANON-PX-3747. The subject is a 80-year-old female with a significant medical history including osteoarthritis, asthma, anxiety. 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 Intravenous route at a dosage of 115mg, initiated on 2025-06-01 for Hypothyroidism and discontinued on 2025-06-28.

On approximately 2025-06-21, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Nausea, Angioedema. The Vomiting was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed policy and advised resource. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Angioedema was classified as Severe in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Unknown'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 4 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: Turn glass interesting. There message into ready bag arm listen.</data>
report_id: ADR-2025-442
report_date: '2025-06-29'
patient_details:
  patient_id: ANON-PX-3747
  gender: Female
  relevant_history:
  - osteoarthritis
  - asthma
  - anxiety
  age_at_reaction: 80
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 115mg
  route_of_administration: Intravenous
  start_date: '2025-06-01'
  indication_for_use: Hypothyroidism
  end_date: '2025-06-28'
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2025-06-21'
  severity: Mild
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed policy and advised resource.
- symptom_name: Nausea
  onset_date: '2025-06-21'
  severity: Mild
  outcome: Unknown
  intervention_required: false
- symptom_name: Angioedema
  onset_date: '2025-06-21'
  severity: Severe
  outcome: Unknown
  intervention_required: true
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 4
reporting_facility: Sandoval, Lawson and Reed Medical Center
reporter_type: Nurse
notes: Turn glass interesting. There message into ready bag arm listen.
