<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-2025-326
Date of Submission: 2025-01-09

This report was submitted by a Pharmacist from Kirby, Garcia and Hart Medical Center concerning patient ANON-PX-2906. The subject is a 42-year-old female with a significant medical history including migraines, atrial fibrillation, hypertension. 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 9mg, initiated on 2024-12-05 for Type 2 diabetes and discontinued on 2024-12-29; Lisinopril (ACE inhibitor) administered via the Oral route at a dosage of 406mg, initiated on 2024-12-05 for Hypertension and discontinued on 2024-12-29.

On approximately 2024-12-13, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Headache, Nausea, Anaphylaxis. The Headache was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed name and advised family. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Anaphylaxis was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed voice and advised type. 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: Market old gun everybody task yourself service. Magazine president history style picture treat course. Toward develop teacher art water.</data>
report_id: ADR-2025-326
report_date: '2025-01-09'
patient_details:
  patient_id: ANON-PX-2906
  gender: Female
  relevant_history:
  - migraines
  - atrial fibrillation
  - hypertension
  age_at_reaction: 42
suspected_drugs:
- drug_name: Metformin
  dosage: 9mg
  route_of_administration: Topical
  start_date: '2024-12-05'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2024-12-29'
- drug_name: Lisinopril
  dosage: 406mg
  route_of_administration: Oral
  start_date: '2024-12-05'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2024-12-29'
adverse_reactions:
- symptom_name: Headache
  onset_date: '2024-12-13'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed name and advised family.
- symptom_name: Nausea
  onset_date: '2024-12-13'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2024-12-13'
  severity: Life-threatening
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed voice and advised type.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Kirby, Garcia and Hart Medical Center
reporter_type: Pharmacist
notes: Market old gun everybody task yourself service. Magazine president history
  style picture treat course. Toward develop teacher art water.
