<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-2024-209
Date of Submission: 2024-12-25

This report was submitted by a Other Healthcare Professional from Gray and Sons Medical Center concerning patient ANON-PX-8294. The subject is an adult male with a significant medical history including hypertension, anxiety, 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 Intravenous route at a dosage of 422mg, initiated on 2024-11-22 for Type 2 diabetes with the course ongoing.

On approximately 2024-11-24, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Diarrhea, Hepatotoxicity. The Pruritus was classified as Severe 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. This necessitated clinical intervention. The documented action was: Prescribed age and advised left. The current patient status regarding this symptom is 'Recovering'. The Hepatotoxicity was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed check and advised report. The current patient status regarding this symptom is 'Not Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 2 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: Create us kind quality example until. Professional among level truth large determine which.</data>
report_id: ADR-2024-209
report_date: '2024-12-25'
patient_details:
  patient_id: ANON-PX-8294
  gender: Male
  relevant_history:
  - hypertension
  - anxiety
  - coronary artery disease
  - chronic kidney disease
suspected_drugs:
- drug_name: Metformin
  dosage: 422mg
  route_of_administration: Intravenous
  start_date: '2024-11-22'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2024-11-24'
  severity: Severe
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2024-11-24'
  severity: Mild
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed age and advised left.
- symptom_name: Hepatotoxicity
  onset_date: '2024-11-24'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed check and advised report.
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Not applicable
  naranjo_score: 2
reporting_facility: Gray and Sons Medical Center
reporter_type: Other Healthcare Professional
notes: Create us kind quality example until. Professional among level truth large
  determine which.
