<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-2025-405
Date of Submission: 2025-03-10

This report was submitted by a Physician from Davis, Bell and Rivera Medical Center concerning patient ANON-PX-6659. The subject is a 48-year-old other with a significant medical history including asthma, chronic kidney disease, type 2 diabetes, atrial fibrillation. 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 Intramuscular route at a dosage of 419mg, initiated on 2025-01-17 for Hypertension with the course ongoing; Amoxicillin administered via the Oral route at a dosage of 193mg, initiated on 2025-01-17 for Bacterial infection with the course ongoing.

On approximately 2025-03-04, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Dizziness, Stevens-Johnson syndrome, Anaphylaxis. The Dizziness was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Stevens-Johnson syndrome was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed fast and advised discuss. The current patient status regarding this symptom is 'Not Recovered'. The Anaphylaxis was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 3 was calculated, The assessment concluded the relationship was 'Possible'. 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: Including bed goal dream. Structure century return fear.</data>
report_id: ADR-2025-405
report_date: '2025-03-10'
patient_details:
  patient_id: ANON-PX-6659
  gender: Other
  relevant_history:
  - asthma
  - chronic kidney disease
  - type 2 diabetes
  - atrial fibrillation
  age_at_reaction: 48
suspected_drugs:
- drug_name: Lisinopril
  dosage: 419mg
  route_of_administration: Intramuscular
  start_date: '2025-01-17'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
- drug_name: Amoxicillin
  dosage: 193mg
  route_of_administration: Oral
  start_date: '2025-01-17'
  indication_for_use: Bacterial infection
adverse_reactions:
- symptom_name: Dizziness
  onset_date: '2025-03-04'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-03-04'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed fast and advised discuss.
- symptom_name: Anaphylaxis
  onset_date: '2025-03-04'
  severity: Severe
  outcome: Fatal
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive dechallenge
  naranjo_score: 3
reporting_facility: Davis, Bell and Rivera Medical Center
reporter_type: Physician
notes: Including bed goal dream. Structure century return fear.
