<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-2025-518
Date of Submission: 2025-04-26

This report was submitted by a Physician from Watson, Kennedy and Shaw Medical Center concerning patient ANON-PX-5179. The subject is a 53-year-old male with a significant medical history including migraines, osteoarthritis, 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): Warfarin (Anticoagulant) administered via the Topical route at a dosage of 433mg, initiated on 2025-04-08 for Thromboembolism prevention and discontinued on 2025-04-24; Lisinopril (ACE inhibitor) administered via the Intramuscular route at a dosage of 486mg, initiated on 2025-04-08 for Hypertension and discontinued on 2025-04-24.

On approximately 2025-04-17, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Hepatotoxicity, Diarrhea, Pruritus. The Hepatotoxicity was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed maintain and advised general. The current patient status regarding this symptom is 'Not Recovered'. The Diarrhea was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Pruritus was classified as Life-threatening in severity. This necessitated clinical intervention. The documented action was: Prescribed military and advised national. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 7 was calculated, The assessment concluded the relationship was 'Probable'. Dechallenge/Rechallenge status was noted as: 'Positive dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Debate scientist pressure common carry. Then watch security past others dream dog road.</data>
report_id: ADR-2025-518
report_date: '2025-04-26'
patient_details:
  patient_id: ANON-PX-5179
  gender: Male
  relevant_history:
  - migraines
  - osteoarthritis
  - type 2 diabetes
  age_at_reaction: 53
suspected_drugs:
- drug_name: Warfarin
  dosage: 433mg
  route_of_administration: Topical
  start_date: '2025-04-08'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
  end_date: '2025-04-24'
- drug_name: Lisinopril
  dosage: 486mg
  route_of_administration: Intramuscular
  start_date: '2025-04-08'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2025-04-24'
adverse_reactions:
- symptom_name: Hepatotoxicity
  onset_date: '2025-04-17'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed maintain and advised general.
- symptom_name: Diarrhea
  onset_date: '2025-04-17'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Pruritus
  onset_date: '2025-04-17'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed military and advised national.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Positive dechallenge
  naranjo_score: 7
reporting_facility: Watson, Kennedy and Shaw Medical Center
reporter_type: Physician
notes: Debate scientist pressure common carry. Then watch security past others dream
  dog road.
