<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-2025-188
Date of Submission: 2025-01-19

This report was submitted by a Physician from Golden-Garcia Medical Center concerning patient ANON-PX-9333. The subject is an adult male with a significant medical history including osteoarthritis, 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): Metformin (Biguanide) administered via the Topical route at a dosage of 17mg, initiated on 2024-11-07 for Type 2 diabetes and discontinued on 2025-01-15.

On approximately 2024-11-29, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Dizziness, Diarrhea. The Dizziness was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Diarrhea was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovering'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. 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: National current try difficult shake. Say couple forget skin get where produce.</data>
report_id: ADR-2025-188
report_date: '2025-01-19'
patient_details:
  patient_id: ANON-PX-9333
  gender: Male
  relevant_history:
  - osteoarthritis
  - coronary artery disease
suspected_drugs:
- drug_name: Metformin
  dosage: 17mg
  route_of_administration: Topical
  start_date: '2024-11-07'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2025-01-15'
adverse_reactions:
- symptom_name: Dizziness
  onset_date: '2024-11-29'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
- symptom_name: Diarrhea
  onset_date: '2024-11-29'
  severity: Mild
  outcome: Recovering
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Golden-Garcia Medical Center
reporter_type: Physician
notes: National current try difficult shake. Say couple forget skin get where produce.
