<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-2024-460
Date of Submission: 2024-10-27

This report was submitted by a Pharmacist from Cox Group Medical Center concerning patient ANON-PX-5681. The subject is an adult female with a significant medical history including asthma, atrial fibrillation, 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 Subcutaneous route at a dosage of 58mg, initiated on 2024-10-07 for Type 2 diabetes and discontinued on 2024-10-22.

On approximately 2024-10-09, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Headache, Stevens-Johnson syndrome, Somnolence, Diarrhea. The Headache was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Stevens-Johnson syndrome was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed ready and advised individual. The current patient status regarding this symptom is 'Fatal'. The Somnolence was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Diarrhea was classified as Mild in severity. No specific therapeutic intervention was required. 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: 'Not applicable'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Quite while sort fund force although identify. Water seem big clearly husband politics.</data>
report_id: ADR-2024-460
report_date: '2024-10-27'
patient_details:
  patient_id: ANON-PX-5681
  gender: Female
  relevant_history:
  - asthma
  - atrial fibrillation
  - anxiety
suspected_drugs:
- drug_name: Metformin
  dosage: 58mg
  route_of_administration: Subcutaneous
  start_date: '2024-10-07'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2024-10-22'
adverse_reactions:
- symptom_name: Headache
  onset_date: '2024-10-09'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2024-10-09'
  severity: Severe
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed ready and advised individual.
- symptom_name: Somnolence
  onset_date: '2024-10-09'
  severity: Severe
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2024-10-09'
  severity: Mild
  outcome: Not Recovered
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Not applicable
  naranjo_score: 1
reporting_facility: Cox Group Medical Center
reporter_type: Pharmacist
notes: Quite while sort fund force although identify. Water seem big clearly husband
  politics.
