<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-2024-598
Date of Submission: 2024-10-23

This report was submitted by a Physician from Stevenson Ltd Medical Center concerning patient ANON-PX-8851. The subject is an adult other with a significant medical history including 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): Metformin (Biguanide) administered via the Topical route at a dosage of 423mg, initiated on 2024-08-10 for Type 2 diabetes with the course ongoing; Atorvastatin administered via the Intramuscular route at a dosage of 211mg, initiated on 2024-08-10 for Hypercholesterolemia with the course ongoing.

On approximately 2024-08-21, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Hepatotoxicity, Vomiting, Pruritus, Nausea. The Hepatotoxicity was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Vomiting was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Pruritus was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed everything and advised large. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed pull and advised court. The current patient status regarding this symptom is 'Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 8 was calculated, The assessment concluded the relationship was 'Probable'. Dechallenge/Rechallenge status was noted as: 'Not applicable'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Deal attack else section hand yet policy general. Learn reach behavior consider not only. Court her west toward.</data>
report_id: ADR-2024-598
report_date: '2024-10-23'
patient_details:
  patient_id: ANON-PX-8851
  gender: Other
  relevant_history:
  - asthma
  - anxiety
suspected_drugs:
- drug_name: Metformin
  dosage: 423mg
  route_of_administration: Topical
  start_date: '2024-08-10'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
- drug_name: Atorvastatin
  dosage: 211mg
  route_of_administration: Intramuscular
  start_date: '2024-08-10'
  indication_for_use: Hypercholesterolemia
adverse_reactions:
- symptom_name: Hepatotoxicity
  onset_date: '2024-08-21'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
- symptom_name: Vomiting
  onset_date: '2024-08-21'
  severity: Mild
  outcome: Fatal
  intervention_required: true
- symptom_name: Pruritus
  onset_date: '2024-08-21'
  severity: Mild
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed everything and advised large.
- symptom_name: Nausea
  onset_date: '2024-08-21'
  severity: Severe
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed pull and advised court.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Not applicable
  naranjo_score: 8
reporting_facility: Stevenson Ltd Medical Center
reporter_type: Physician
notes: Deal attack else section hand yet policy general. Learn reach behavior consider
  not only. Court her west toward.
