<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-2025-481
Date of Submission: 2025-07-03

This report was submitted by a Physician from Moore, Wilson and Mosley Medical Center concerning patient ANON-PX-6617. The subject is an adult female with a significant medical history including chronic kidney disease, type 2 diabetes, seasonal allergies, atrial fibrillation. 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 Subcutaneous route at a dosage of 97mg, initiated on 2025-04-08 for Hypothyroidism and discontinued on 2025-06-22.

On approximately 2025-06-22, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Angioedema, Stevens-Johnson syndrome. The Angioedema was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Stevens-Johnson syndrome was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Unknown'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. 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. 

</data>
report_id: ADR-2025-481
report_date: '2025-07-03'
patient_details:
  patient_id: ANON-PX-6617
  gender: Female
  relevant_history:
  - chronic kidney disease
  - type 2 diabetes
  - seasonal allergies
  - atrial fibrillation
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 97mg
  route_of_administration: Subcutaneous
  start_date: '2025-04-08'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-06-22'
adverse_reactions:
- symptom_name: Angioedema
  onset_date: '2025-06-22'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-06-22'
  severity: Mild
  outcome: Unknown
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Moore, Wilson and Mosley Medical Center
reporter_type: Physician
