<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-2025-423
Date of Submission: 2025-05-11

This report was submitted by a Nurse from Cunningham, Murray and Singh Medical Center concerning patient ANON-PX-6585. The subject is a 79-year-old male with a significant medical history including asthma, chronic kidney disease, migraines, 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 Topical route at a dosage of 23mg, initiated on 2025-04-11 for Hypothyroidism with the course ongoing; Gabapentin (Anticonvulsant) administered via the Oral route at a dosage of 5mg, initiated on 2025-04-11 for Neuropathic pain with the course ongoing.

On approximately 2025-04-28, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Maculopapular Rash, Hepatotoxicity. The Maculopapular Rash was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed hit and advised guy. The current patient status regarding this symptom is 'Not Recovered'. The Hepatotoxicity was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed civil and advised event. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 10 was calculated, The assessment concluded the relationship was 'Highly Probable'. Dechallenge/Rechallenge status was noted as: 'Negative dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Early audience whether focus radio relate case. Much until well forward place we.</data>
report_id: ADR-2025-423
report_date: '2025-05-11'
patient_details:
  patient_id: ANON-PX-6585
  gender: Male
  relevant_history:
  - asthma
  - chronic kidney disease
  - migraines
  - atrial fibrillation
  age_at_reaction: 79
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 23mg
  route_of_administration: Topical
  start_date: '2025-04-11'
  indication_for_use: Hypothyroidism
- drug_name: Gabapentin
  dosage: 5mg
  route_of_administration: Oral
  start_date: '2025-04-11'
  indication_for_use: Neuropathic pain
  drug_class: Anticonvulsant
adverse_reactions:
- symptom_name: Maculopapular Rash
  onset_date: '2025-04-28'
  severity: Severe
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed hit and advised guy.
- symptom_name: Hepatotoxicity
  onset_date: '2025-04-28'
  severity: Severe
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed civil and advised event.
causality_assessment:
  assessment_conclusion: Highly Probable
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 10
reporting_facility: Cunningham, Murray and Singh Medical Center
reporter_type: Nurse
notes: Early audience whether focus radio relate case. Much until well forward place
  we.
