<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-2024-235
Date of Submission: 2024-09-12

This report was submitted by a Nurse from Miller, Freeman and Baldwin Medical Center concerning patient ANON-PX-4057. The subject is an adult other with a significant medical history including seasonal allergies, coronary artery disease, type 2 diabetes, osteoarthritis. 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 Oral route at a dosage of 240mg, initiated on 2024-07-15 for Hypothyroidism and discontinued on 2024-09-06; Metformin (Biguanide) administered via the Intramuscular route at a dosage of 212mg, initiated on 2024-07-15 for Type 2 diabetes and discontinued on 2024-09-06.

On approximately 2024-07-24, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Dizziness, Nausea, Headache, Anaphylaxis. The Dizziness was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovered'. The Nausea was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Headache was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed stuff and advised explain. The current patient status regarding this symptom is 'Recovering'. The Anaphylaxis was classified as Severe in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Not Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 7 was calculated, The assessment concluded the relationship was '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: Around alone both special worker science special. I discussion Republican hotel bar seek.</data>
report_id: ADR-2024-235
report_date: '2024-09-12'
patient_details:
  patient_id: ANON-PX-4057
  gender: Other
  relevant_history:
  - seasonal allergies
  - coronary artery disease
  - type 2 diabetes
  - osteoarthritis
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 240mg
  route_of_administration: Oral
  start_date: '2024-07-15'
  indication_for_use: Hypothyroidism
  end_date: '2024-09-06'
- drug_name: Metformin
  dosage: 212mg
  route_of_administration: Intramuscular
  start_date: '2024-07-15'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2024-09-06'
adverse_reactions:
- symptom_name: Dizziness
  onset_date: '2024-07-24'
  severity: Life-threatening
  outcome: Recovered
  intervention_required: true
- symptom_name: Nausea
  onset_date: '2024-07-24'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Headache
  onset_date: '2024-07-24'
  severity: Moderate
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed stuff and advised explain.
- symptom_name: Anaphylaxis
  onset_date: '2024-07-24'
  severity: Severe
  outcome: Not Recovered
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 7
reporting_facility: Miller, Freeman and Baldwin Medical Center
reporter_type: Nurse
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