<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-2024-854
Date of Submission: 2024-11-24

This report was submitted by a Nurse from Hubbard-Holder Medical Center concerning patient ANON-PX-2638. The subject is a 29-year-old female with a significant medical history including coronary artery disease, asthma, type 2 diabetes, hypertension. 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 Subcutaneous route at a dosage of 424mg, initiated on 2024-11-09 for Type 2 diabetes and discontinued on 2024-11-22; Levothyroxine (Thyroid hormone) administered via the Subcutaneous route at a dosage of 208mg, initiated on 2024-11-09 for Hypothyroidism and discontinued on 2024-11-22.

On approximately 2024-11-19, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Angioedema, Anaphylaxis. The Angioedema was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Anaphylaxis was classified as Severe 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 5 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: Short far newspaper rich southern director. Magazine southern state notice. Theory cause road tree provide stage. Newspaper her weight economic benefit benefit.</data>
report_id: ADR-2024-854
report_date: '2024-11-24'
patient_details:
  patient_id: ANON-PX-2638
  gender: Female
  relevant_history:
  - coronary artery disease
  - asthma
  - type 2 diabetes
  - hypertension
  age_at_reaction: 29
suspected_drugs:
- drug_name: Metformin
  dosage: 424mg
  route_of_administration: Subcutaneous
  start_date: '2024-11-09'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2024-11-22'
- drug_name: Levothyroxine
  dosage: 208mg
  route_of_administration: Subcutaneous
  start_date: '2024-11-09'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2024-11-22'
adverse_reactions:
- symptom_name: Angioedema
  onset_date: '2024-11-19'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2024-11-19'
  severity: Severe
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Rechallenge not performed
  naranjo_score: 5
reporting_facility: Hubbard-Holder Medical Center
reporter_type: Nurse
notes: Short far newspaper rich southern director. Magazine southern state notice.
  Theory cause road tree provide stage. Newspaper her weight economic benefit benefit.
