<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-2024-970
Date of Submission: 2024-11-12

This report was submitted by a Nurse from Hamilton, Young and Sharp Medical Center concerning patient ANON-PX-6916. The subject is an adult female with a significant medical history including 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): Atorvastatin (Statin) administered via the Topical route at a dosage of 65mg, initiated on 2024-09-10 for Hypercholesterolemia with the course ongoing; Metformin administered via the Topical route at a dosage of 274mg, initiated on 2024-09-10 for Type 2 diabetes with the course ongoing.

On approximately 2024-09-21, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Nausea, Dizziness, Vomiting, Diarrhea. The Nausea was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed fire and advised particularly. The current patient status regarding this symptom is 'Recovered'. The Dizziness was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed respond and advised reason. The current patient status regarding this symptom is 'Fatal'. The Vomiting was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Diarrhea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 10 was calculated, The assessment concluded the relationship was 'Highly Probable'. 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: Idea daughter Mrs. Support design true art.</data>
report_id: ADR-2024-970
report_date: '2024-11-12'
patient_details:
  patient_id: ANON-PX-6916
  gender: Female
  relevant_history:
  - coronary artery disease
  - type 2 diabetes
  - osteoarthritis
suspected_drugs:
- drug_name: Atorvastatin
  dosage: 65mg
  route_of_administration: Topical
  start_date: '2024-09-10'
  indication_for_use: Hypercholesterolemia
  drug_class: Statin
- drug_name: Metformin
  dosage: 274mg
  route_of_administration: Topical
  start_date: '2024-09-10'
  indication_for_use: Type 2 diabetes
adverse_reactions:
- symptom_name: Nausea
  onset_date: '2024-09-21'
  severity: Mild
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed fire and advised particularly.
- symptom_name: Dizziness
  onset_date: '2024-09-21'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed respond and advised reason.
- symptom_name: Vomiting
  onset_date: '2024-09-21'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2024-09-21'
  severity: Mild
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Highly Probable
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 10
reporting_facility: Hamilton, Young and Sharp Medical Center
reporter_type: Nurse
notes: Idea daughter Mrs. Support design true art.
