<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-2025-960
Date of Submission: 2025-06-25

This report was submitted by a Nurse from Fisher PLC Medical Center concerning patient ANON-PX-6876. The subject is an adult female with a significant medical history including osteoarthritis, chronic kidney disease, atrial fibrillation, migraines. 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 administered via the Oral route at a dosage of 247mg, initiated on 2025-06-09 for Type 2 diabetes and discontinued on 2025-06-22.

On approximately 2025-06-18, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Dizziness, Vomiting, Anaphylaxis. The Dizziness was classified as Severe in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovered'. The Vomiting was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed security and advised be. The current patient status regarding this symptom is 'Not Recovered'. The Anaphylaxis was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed example and advised truth. The current patient status regarding this symptom is '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: 'Positive rechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Course not research let week difficult. Large fund spring might. Community each material strong lot attack will.</data>
report_id: ADR-2025-960
report_date: '2025-06-25'
patient_details:
  patient_id: ANON-PX-6876
  gender: Female
  relevant_history:
  - osteoarthritis
  - chronic kidney disease
  - atrial fibrillation
  - migraines
suspected_drugs:
- drug_name: Metformin
  dosage: 247mg
  route_of_administration: Oral
  start_date: '2025-06-09'
  indication_for_use: Type 2 diabetes
  end_date: '2025-06-22'
adverse_reactions:
- symptom_name: Dizziness
  onset_date: '2025-06-18'
  severity: Severe
  outcome: Recovered
  intervention_required: true
- symptom_name: Vomiting
  onset_date: '2025-06-18'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed security and advised be.
- symptom_name: Anaphylaxis
  onset_date: '2025-06-18'
  severity: Life-threatening
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed example and advised truth.
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 1
reporting_facility: Fisher PLC Medical Center
reporter_type: Nurse
notes: Course not research let week difficult. Large fund spring might. Community
  each material strong lot attack will.
