<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-2025-451
Date of Submission: 2025-02-20

This report was submitted by a Nurse from Stephens-Martin Medical Center concerning patient ANON-PX-4842. The subject is an adult male with a significant medical history including anxiety, chronic kidney disease, asthma. 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): Warfarin administered via the Oral route at a dosage of 392mg, initiated on 2024-12-02 for Thromboembolism prevention and discontinued on 2025-02-16.

On approximately 2025-02-10, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Hepatotoxicity, Nausea. 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. This necessitated clinical intervention. The documented action was: Prescribed policy and advised usually. The current patient status regarding this symptom is 'Not Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 1 was calculated, The assessment concluded the relationship was 'Possible'. 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: Toward tonight side.</data>
report_id: ADR-2025-451
report_date: '2025-02-20'
patient_details:
  patient_id: ANON-PX-4842
  gender: Male
  relevant_history:
  - anxiety
  - chronic kidney disease
  - asthma
suspected_drugs:
- drug_name: Warfarin
  dosage: 392mg
  route_of_administration: Oral
  start_date: '2024-12-02'
  indication_for_use: Thromboembolism prevention
  end_date: '2025-02-16'
adverse_reactions:
- symptom_name: Hepatotoxicity
  onset_date: '2025-02-10'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2025-02-10'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed policy and advised usually.
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Rechallenge not performed
  naranjo_score: 1
reporting_facility: Stephens-Martin Medical Center
reporter_type: Nurse
notes: Toward tonight side.
