<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-2025-244
Date of Submission: 2025-04-14

This report was submitted by a Nurse from Jackson and Sons Medical Center concerning patient ANON-PX-8206. The subject is a 40-year-old male with a significant medical history including osteoarthritis, chronic kidney disease, type 2 diabetes, asthma. 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): Ibuprofen administered via the Intramuscular route at a dosage of 228mg, initiated on 2025-02-05 for Pain and inflammation with the course ongoing; Lisinopril administered via the Topical route at a dosage of 220mg, initiated on 2025-02-05 for Hypertension with the course ongoing.

On approximately 2025-02-27, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Somnolence, Diarrhea, Hepatotoxicity, Anaphylaxis. The Vomiting was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Somnolence was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Hepatotoxicity was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Anaphylaxis was classified as Severe in severity. This necessitated clinical intervention. The documented action was: Prescribed black and advised staff. The current patient status regarding this symptom is 'Recovering'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 5 was calculated, The assessment concluded the relationship was 'Probable'. 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: Wind vote city score water good.</data>
report_id: ADR-2025-244
report_date: '2025-04-14'
patient_details:
  patient_id: ANON-PX-8206
  gender: Male
  relevant_history:
  - osteoarthritis
  - chronic kidney disease
  - type 2 diabetes
  - asthma
  age_at_reaction: 40
suspected_drugs:
- drug_name: Ibuprofen
  dosage: 228mg
  route_of_administration: Intramuscular
  start_date: '2025-02-05'
  indication_for_use: Pain and inflammation
- drug_name: Lisinopril
  dosage: 220mg
  route_of_administration: Topical
  start_date: '2025-02-05'
  indication_for_use: Hypertension
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2025-02-27'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Somnolence
  onset_date: '2025-02-27'
  severity: Mild
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-02-27'
  severity: Mild
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Hepatotoxicity
  onset_date: '2025-02-27'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
- symptom_name: Anaphylaxis
  onset_date: '2025-02-27'
  severity: Severe
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed black and advised staff.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Positive dechallenge
  naranjo_score: 5
reporting_facility: Jackson and Sons Medical Center
reporter_type: Nurse
notes: Wind vote city score water good.
