<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-2025-715
Date of Submission: 2025-05-05

This report was submitted by a Pharmacist from Cohen, Brown and Bernard Medical Center concerning patient ANON-PX-4481. The subject is a 39-year-old female with a significant medical history including asthma, anxiety. 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 31mg, initiated on 2025-03-05 for Type 2 diabetes and discontinued on 2025-05-04.

On approximately 2025-04-08, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Diarrhea, Hepatotoxicity, Dizziness. The Diarrhea was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Hepatotoxicity was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Dizziness was classified as Moderate 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: 'Not applicable'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Section despite important low. South concern without huge effort condition win.</data>
report_id: ADR-2025-715
report_date: '2025-05-05'
patient_details:
  patient_id: ANON-PX-4481
  gender: Female
  relevant_history:
  - asthma
  - anxiety
  age_at_reaction: 39
suspected_drugs:
- drug_name: Metformin
  dosage: 31mg
  route_of_administration: Intramuscular
  start_date: '2025-03-05'
  indication_for_use: Type 2 diabetes
  drug_class: Biguanide
  end_date: '2025-05-04'
adverse_reactions:
- symptom_name: Diarrhea
  onset_date: '2025-04-08'
  severity: Moderate
  outcome: Recovered
  intervention_required: false
- symptom_name: Hepatotoxicity
  onset_date: '2025-04-08'
  severity: Mild
  outcome: Fatal
  intervention_required: true
- symptom_name: Dizziness
  onset_date: '2025-04-08'
  severity: Moderate
  outcome: Fatal
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Not applicable
reporting_facility: Cohen, Brown and Bernard Medical Center
reporter_type: Pharmacist
notes: Section despite important low. South concern without huge effort condition
  win.
