<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-2024-305
Date of Submission: 2024-11-12

This report was submitted by a Physician from Norris, Dennis and Johnson Medical Center concerning patient ANON-PX-7711. The subject is a 45-year-old other with a significant medical history including anxiety, asthma, coronary artery disease, chronic kidney disease. 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 Intramuscular route at a dosage of 465mg, initiated on 2024-10-04 for Type 2 diabetes and discontinued on 2024-10-20; Levothyroxine (Thyroid hormone) administered via the Intramuscular route at a dosage of 461mg, initiated on 2024-10-04 for Hypothyroidism and discontinued on 2024-10-20.

On approximately 2024-10-18, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Stevens-Johnson syndrome, Headache, Maculopapular Rash, Nausea. The Stevens-Johnson syndrome was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed finish and advised choose. The current patient status regarding this symptom is 'Unknown'. The Headache was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Maculopapular Rash was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Nausea was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed eye and advised mission. The current patient status regarding this symptom is 'Unknown'. 

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: 'Not applicable'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Including director fly debate. Land amount what military.</data>
report_id: ADR-2024-305
report_date: '2024-11-12'
patient_details:
  patient_id: ANON-PX-7711
  gender: Other
  relevant_history:
  - anxiety
  - asthma
  - coronary artery disease
  - chronic kidney disease
  age_at_reaction: 45
suspected_drugs:
- drug_name: Metformin
  dosage: 465mg
  route_of_administration: Intramuscular
  start_date: '2024-10-04'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2024-10-20'
- drug_name: Levothyroxine
  dosage: 461mg
  route_of_administration: Intramuscular
  start_date: '2024-10-04'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2024-10-20'
adverse_reactions:
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2024-10-18'
  severity: Moderate
  outcome: Unknown
  intervention_required: true
  intervention_details: Prescribed finish and advised choose.
- symptom_name: Headache
  onset_date: '2024-10-18'
  severity: Moderate
  outcome: Unknown
  intervention_required: false
- symptom_name: Maculopapular Rash
  onset_date: '2024-10-18'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2024-10-18'
  severity: Mild
  outcome: Unknown
  intervention_required: true
  intervention_details: Prescribed eye and advised mission.
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Not applicable
  naranjo_score: 3
reporting_facility: Norris, Dennis and Johnson Medical Center
reporter_type: Physician
notes: Including director fly debate. Land amount what military.
