<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-2024-443
Date of Submission: 2024-09-16

This report was submitted by a Physician from Clark and Sons Medical Center concerning patient ANON-PX-4432. The subject is a 43-year-old female with a significant medical history including osteoarthritis, 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): Levothyroxine administered via the Oral route at a dosage of 443mg, initiated on 2024-07-12 for Hypothyroidism and discontinued on 2024-08-21; Atorvastatin (Statin) administered via the Topical route at a dosage of 115mg, initiated on 2024-07-12 for Hypercholesterolemia and discontinued on 2024-08-21.

On approximately 2024-07-15, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Headache, Maculopapular Rash, Hepatotoxicity. The Headache was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Maculopapular Rash was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed western and advised scientist. The current patient status regarding this symptom is 'Fatal'. The Hepatotoxicity was classified as Severe in severity. No specific therapeutic intervention was required. 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: 'Positive rechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Full power reveal born safe. Behavior throw between book.</data>
report_id: ADR-2024-443
report_date: '2024-09-16'
patient_details:
  patient_id: ANON-PX-4432
  gender: Female
  relevant_history:
  - osteoarthritis
  - atrial fibrillation
  age_at_reaction: 43
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 443mg
  route_of_administration: Oral
  start_date: '2024-07-12'
  indication_for_use: Hypothyroidism
  end_date: '2024-08-21'
- drug_name: Atorvastatin
  dosage: 115mg
  route_of_administration: Topical
  start_date: '2024-07-12'
  indication_for_use: Hypercholesterolemia
  drug_class: Statin
  end_date: '2024-08-21'
adverse_reactions:
- symptom_name: Headache
  onset_date: '2024-07-15'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Maculopapular Rash
  onset_date: '2024-07-15'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed western and advised scientist.
- symptom_name: Hepatotoxicity
  onset_date: '2024-07-15'
  severity: Severe
  outcome: Not Recovered
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Positive rechallenge
reporting_facility: Clark and Sons Medical Center
reporter_type: Physician
notes: Full power reveal born safe. Behavior throw between book.
