<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-2025-206
Date of Submission: 2025-06-30

This report was submitted by a Patient from Klein Inc Medical Center concerning patient ANON-PX-3180. The subject is a 69-year-old male with a significant medical history including coronary artery disease, asthma, 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): Lisinopril (ACE inhibitor) administered via the Subcutaneous route at a dosage of 373mg, initiated on 2025-05-14 for Hypertension and discontinued on 2025-06-28; Warfarin (Anticoagulant) administered via the Intravenous route at a dosage of 436mg, initiated on 2025-05-14 for Thromboembolism prevention and discontinued on 2025-06-28.

On approximately 2025-06-02, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Stevens-Johnson syndrome, Dizziness. The Vomiting was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Stevens-Johnson syndrome was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Dizziness was classified as Severe 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 2 was calculated, The assessment concluded the relationship was 'Possible'. Dechallenge/Rechallenge status was noted as: 'Positive dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Visit trip customer three body structure. Consider suffer trouble result wait want if at. While against popular often television good.</data>
report_id: ADR-2025-206
report_date: '2025-06-30'
patient_details:
  patient_id: ANON-PX-3180
  gender: Male
  relevant_history:
  - coronary artery disease
  - asthma
  - hypertension
  age_at_reaction: 69
suspected_drugs:
- drug_name: Lisinopril
  dosage: 373mg
  route_of_administration: Subcutaneous
  start_date: '2025-05-14'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2025-06-28'
- drug_name: Warfarin
  dosage: 436mg
  route_of_administration: Intravenous
  start_date: '2025-05-14'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
  end_date: '2025-06-28'
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2025-06-02'
  severity: Mild
  outcome: Recovered
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-06-02'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Dizziness
  onset_date: '2025-06-02'
  severity: Severe
  outcome: Unknown
  intervention_required: true
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive dechallenge
  naranjo_score: 2
reporting_facility: Klein Inc Medical Center
reporter_type: Patient
notes: Visit trip customer three body structure. Consider suffer trouble result wait
  want if at. While against popular often television good.
