<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-2025-729
Date of Submission: 2025-03-26

This report was submitted by a Pharmacist from Fisher, Bishop and Tyler Medical Center concerning patient ANON-PX-1457. The subject is an adult female with a significant medical history including asthma, type 2 diabetes. 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): Levothyroxine (Thyroid hormone) administered via the Topical route at a dosage of 157mg, initiated on 2025-01-01 for Hypothyroidism and discontinued on 2025-03-10.

On approximately 2025-01-21, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Hepatotoxicity, Nausea, Stevens-Johnson syndrome, Diarrhea, Dizziness. The Hepatotoxicity was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Nausea was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Stevens-Johnson syndrome was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Diarrhea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Dizziness was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed his and advised audience. The current patient status regarding this symptom is 'Fatal'. 

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: 'Negative dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Fall authority condition play national. Religious she itself them green.</data>
report_id: ADR-2025-729
report_date: '2025-03-26'
patient_details:
  patient_id: ANON-PX-1457
  gender: Female
  relevant_history:
  - asthma
  - type 2 diabetes
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 157mg
  route_of_administration: Topical
  start_date: '2025-01-01'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-03-10'
adverse_reactions:
- symptom_name: Hepatotoxicity
  onset_date: '2025-01-21'
  severity: Life-threatening
  outcome: Recovered
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2025-01-21'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-01-21'
  severity: Severe
  outcome: Unknown
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-01-21'
  severity: Life-threatening
  outcome: Recovered
  intervention_required: false
- symptom_name: Dizziness
  onset_date: '2025-01-21'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed his and advised audience.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 5
reporting_facility: Fisher, Bishop and Tyler Medical Center
reporter_type: Pharmacist
notes: Fall authority condition play national. Religious she itself them green.
