<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-2025-651
Date of Submission: 2025-05-12

This report was submitted by a Nurse from Leonard Ltd Medical Center concerning patient ANON-PX-1864. The subject is an adult other with a significant medical history including seasonal allergies, asthma, atrial fibrillation, chronic kidney disease. 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 Oral route at a dosage of 156mg, initiated on 2025-04-30 for Type 2 diabetes and discontinued on 2025-05-11; Levothyroxine administered via the Oral route at a dosage of 90mg, initiated on 2025-04-30 for Hypothyroidism and discontinued on 2025-05-11.

On approximately 2025-05-10, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Stevens-Johnson syndrome, Hepatotoxicity, Nausea, Pruritus, Headache. 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 Hepatotoxicity was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Pruritus was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Headache was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed win and advised security. The current patient status regarding this symptom is 'Not Recovered'. 

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: Crime movie draw activity high avoid know skill. Think speech its time computer month computer. Mention gun these today every director of.</data>
report_id: ADR-2025-651
report_date: '2025-05-12'
patient_details:
  patient_id: ANON-PX-1864
  gender: Other
  relevant_history:
  - seasonal allergies
  - asthma
  - atrial fibrillation
  - chronic kidney disease
suspected_drugs:
- drug_name: Metformin
  dosage: 156mg
  route_of_administration: Oral
  start_date: '2025-04-30'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2025-05-11'
- drug_name: Levothyroxine
  dosage: 90mg
  route_of_administration: Oral
  start_date: '2025-04-30'
  indication_for_use: Hypothyroidism
  end_date: '2025-05-11'
adverse_reactions:
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-05-10'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Hepatotoxicity
  onset_date: '2025-05-10'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2025-05-10'
  severity: Life-threatening
  outcome: Recovering
  intervention_required: false
- symptom_name: Pruritus
  onset_date: '2025-05-10'
  severity: Severe
  outcome: Recovered
  intervention_required: false
- symptom_name: Headache
  onset_date: '2025-05-10'
  severity: Mild
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed win and advised security.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Leonard Ltd Medical Center
reporter_type: Nurse
notes: Crime movie draw activity high avoid know skill. Think speech its time computer
  month computer. Mention gun these today every director of.
