<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-2025-508
Date of Submission: 2025-06-13

This report was submitted by a Other Healthcare Professional from Ortiz, Harris and Davis Medical Center concerning patient ANON-PX-5499. The subject is a 29-year-old male with a significant medical history including chronic kidney disease, coronary artery 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): Warfarin (Anticoagulant) administered via the Subcutaneous route at a dosage of 139mg, initiated on 2025-05-03 for Thromboembolism prevention and discontinued on 2025-05-30.

On approximately 2025-05-06, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Stevens-Johnson syndrome, Diarrhea. The Stevens-Johnson syndrome 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 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. The assessment concluded the relationship was 'Probable'. Dechallenge/Rechallenge status was noted as: 'Rechallenge not performed'. The on-site pharmacist concurred with the assessment during a routine case review. 

</data>
report_id: ADR-2025-508
report_date: '2025-06-13'
patient_details:
  patient_id: ANON-PX-5499
  gender: Male
  relevant_history:
  - chronic kidney disease
  - coronary artery disease
  age_at_reaction: 29
suspected_drugs:
- drug_name: Warfarin
  dosage: 139mg
  route_of_administration: Subcutaneous
  start_date: '2025-05-03'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
  end_date: '2025-05-30'
adverse_reactions:
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-05-06'
  severity: Severe
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-05-06'
  severity: Severe
  outcome: Fatal
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Rechallenge not performed
reporting_facility: Ortiz, Harris and Davis Medical Center
reporter_type: Other Healthcare Professional
