<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-2025-570
Date of Submission: 2025-07-13

This report was submitted by a Physician from Fuller, Davis and Avila Medical Center concerning patient ANON-PX-3154. The subject is a 79-year-old female with a significant medical history including coronary artery disease, type 2 diabetes, osteoarthritis, 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): Warfarin (Anticoagulant) administered via the Topical route at a dosage of 38mg, initiated on 2025-05-08 for Thromboembolism prevention with the course ongoing; Lisinopril administered via the Topical route at a dosage of 368mg, initiated on 2025-05-08 for Hypertension with the course ongoing.

On approximately 2025-06-24, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Dizziness, Vomiting, Anaphylaxis. The Dizziness was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed guy and advised black. 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 'Not Recovered'. The Anaphylaxis was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Unknown'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 9 was calculated, The assessment concluded the relationship was 'Highly 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: House game approach picture kind. Manager some side address service.</data>
report_id: ADR-2025-570
report_date: '2025-07-13'
patient_details:
  patient_id: ANON-PX-3154
  gender: Female
  relevant_history:
  - coronary artery disease
  - type 2 diabetes
  - osteoarthritis
  - hypertension
  age_at_reaction: 79
suspected_drugs:
- drug_name: Warfarin
  dosage: 38mg
  route_of_administration: Topical
  start_date: '2025-05-08'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
- drug_name: Lisinopril
  dosage: 368mg
  route_of_administration: Topical
  start_date: '2025-05-08'
  indication_for_use: Hypertension
adverse_reactions:
- symptom_name: Dizziness
  onset_date: '2025-06-24'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed guy and advised black.
- symptom_name: Vomiting
  onset_date: '2025-06-24'
  severity: Mild
  outcome: Not Recovered
  intervention_required: true
- symptom_name: Anaphylaxis
  onset_date: '2025-06-24'
  severity: Mild
  outcome: Unknown
  intervention_required: true
causality_assessment:
  assessment_conclusion: Highly Probable
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 9
reporting_facility: Fuller, Davis and Avila Medical Center
reporter_type: Physician
notes: House game approach picture kind. Manager some side address service.
