<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-2025-866
Date of Submission: 2025-05-31

This report was submitted by a Pharmacist from Brown and Sons Medical Center concerning patient ANON-PX-2513. The subject is a 89-year-old other with a significant medical history including chronic kidney disease, hypertension, seasonal allergies. 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 Intravenous route at a dosage of 435mg, initiated on 2025-03-15 for Type 2 diabetes and discontinued on 2025-05-08.

On approximately 2025-04-03, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Headache, Vomiting, Anaphylaxis, Angioedema, Maculopapular Rash. The Headache was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovering'. The Vomiting was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed question and advised drug. The current patient status regarding this symptom is 'Recovered'. The Anaphylaxis was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Angioedema was classified as Severe in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Not Recovered'. The Maculopapular Rash 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 3 was calculated, The assessment concluded the relationship was 'Possible'. 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: Me behind care exist design report. Peace school wide certain present people prevent book. My least organization never camera pretty.</data>
report_id: ADR-2025-866
report_date: '2025-05-31'
patient_details:
  patient_id: ANON-PX-2513
  gender: Other
  relevant_history:
  - chronic kidney disease
  - hypertension
  - seasonal allergies
  age_at_reaction: 89
suspected_drugs:
- drug_name: Metformin
  dosage: 435mg
  route_of_administration: Intravenous
  start_date: '2025-03-15'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2025-05-08'
adverse_reactions:
- symptom_name: Headache
  onset_date: '2025-04-03'
  severity: Life-threatening
  outcome: Recovering
  intervention_required: true
- symptom_name: Vomiting
  onset_date: '2025-04-03'
  severity: Moderate
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed question and advised drug.
- symptom_name: Anaphylaxis
  onset_date: '2025-04-03'
  severity: Life-threatening
  outcome: Recovering
  intervention_required: false
- symptom_name: Angioedema
  onset_date: '2025-04-03'
  severity: Severe
  outcome: Not Recovered
  intervention_required: true
- symptom_name: Maculopapular Rash
  onset_date: '2025-04-03'
  severity: Severe
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 3
reporting_facility: Brown and Sons Medical Center
reporter_type: Pharmacist
notes: Me behind care exist design report. Peace school wide certain present people
  prevent book. My least organization never camera pretty.
