<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-2025-324
Date of Submission: 2025-05-13

This report was submitted by a Physician from Durham, Macias and Powell Medical Center concerning patient ANON-PX-3571. The subject is an adult male with a significant medical history including seasonal allergies, chronic kidney disease, hypertension, atrial fibrillation. 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 (Biguanide) administered via the Intravenous route at a dosage of 360mg, initiated on 2025-04-12 for Type 2 diabetes with the course ongoing; Levothyroxine administered via the Subcutaneous route at a dosage of 5mg, initiated on 2025-04-12 for Hypothyroidism with the course ongoing.

On approximately 2025-05-02, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Diarrhea, Pruritus, Angioedema. The Diarrhea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Pruritus was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed citizen and advised much. The current patient status regarding this symptom is 'Recovered'. The Angioedema was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 7 was calculated, The assessment concluded the relationship was '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: Effort magazine discover player country middle.</data>
report_id: ADR-2025-324
report_date: '2025-05-13'
patient_details:
  patient_id: ANON-PX-3571
  gender: Male
  relevant_history:
  - seasonal allergies
  - chronic kidney disease
  - hypertension
  - atrial fibrillation
suspected_drugs:
- drug_name: Metformin
  dosage: 360mg
  route_of_administration: Intravenous
  start_date: '2025-04-12'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
- drug_name: Levothyroxine
  dosage: 5mg
  route_of_administration: Subcutaneous
  start_date: '2025-04-12'
  indication_for_use: Hypothyroidism
adverse_reactions:
- symptom_name: Diarrhea
  onset_date: '2025-05-02'
  severity: Life-threatening
  outcome: Unknown
  intervention_required: false
- symptom_name: Pruritus
  onset_date: '2025-05-02'
  severity: Moderate
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed citizen and advised much.
- symptom_name: Angioedema
  onset_date: '2025-05-02'
  severity: Mild
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Rechallenge not performed
  naranjo_score: 7
reporting_facility: Durham, Macias and Powell Medical Center
reporter_type: Physician
notes: Effort magazine discover player country middle.
