<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-2025-132
Date of Submission: 2025-06-26

This report was submitted by a Physician from Fisher, Hardy and Shelton Medical Center concerning patient ANON-PX-6284. The subject is an adult other with a significant medical history including seasonal allergies, coronary artery disease. 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 469mg, initiated on 2025-06-16 for Hypertension and discontinued on 2025-06-25; Levothyroxine (Thyroid hormone) administered via the Oral route at a dosage of 298mg, initiated on 2025-06-16 for Hypothyroidism and discontinued on 2025-06-25.

On approximately 2025-06-23, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Nausea, Diarrhea. The Pruritus was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed impact and advised but. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. 

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: 'Not applicable'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Democrat society candidate difficult quality. Someone event since peace may agree.</data>
report_id: ADR-2025-132
report_date: '2025-06-26'
patient_details:
  patient_id: ANON-PX-6284
  gender: Other
  relevant_history:
  - seasonal allergies
  - coronary artery disease
suspected_drugs:
- drug_name: Lisinopril
  dosage: 469mg
  route_of_administration: Subcutaneous
  start_date: '2025-06-16'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2025-06-25'
- drug_name: Levothyroxine
  dosage: 298mg
  route_of_administration: Oral
  start_date: '2025-06-16'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-06-25'
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2025-06-23'
  severity: Mild
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed impact and advised but.
- symptom_name: Nausea
  onset_date: '2025-06-23'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-06-23'
  severity: Life-threatening
  outcome: Recovering
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Not applicable
  naranjo_score: 7
reporting_facility: Fisher, Hardy and Shelton Medical Center
reporter_type: Physician
notes: Democrat society candidate difficult quality. Someone event since peace may
  agree.
