<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-2025-957
Date of Submission: 2025-07-25

This report was submitted by a Nurse from Garrett-Davis Medical Center concerning patient ANON-PX-3683. The subject is a 18-year-old other with a significant medical history including chronic kidney disease, hypertension, migraines, 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): Ibuprofen administered via the Topical route at a dosage of 359mg, initiated on 2025-06-05 for Pain and inflammation with the course ongoing; Metformin administered via the Subcutaneous route at a dosage of 344mg, initiated on 2025-06-05 for Type 2 diabetes with the course ongoing.

On approximately 2025-06-07, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Angioedema, Dizziness, Diarrhea, Pruritus. The Angioedema was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Not Recovered'. The Dizziness was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed road and advised toward. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Pruritus was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 1 was calculated, The assessment concluded the relationship was 'Possible'. Dechallenge/Rechallenge status was noted as: 'Positive rechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Imagine memory hair huge itself side heart. Number father war fish. Total could tough in institution everyone listen them.</data>
report_id: ADR-2025-957
report_date: '2025-07-25'
patient_details:
  patient_id: ANON-PX-3683
  gender: Other
  relevant_history:
  - chronic kidney disease
  - hypertension
  - migraines
  - type 2 diabetes
  age_at_reaction: 18
suspected_drugs:
- drug_name: Ibuprofen
  dosage: 359mg
  route_of_administration: Topical
  start_date: '2025-06-05'
  indication_for_use: Pain and inflammation
- drug_name: Metformin
  dosage: 344mg
  route_of_administration: Subcutaneous
  start_date: '2025-06-05'
  indication_for_use: Type 2 diabetes
adverse_reactions:
- symptom_name: Angioedema
  onset_date: '2025-06-07'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: true
- symptom_name: Dizziness
  onset_date: '2025-06-07'
  severity: Mild
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed road and advised toward.
- symptom_name: Diarrhea
  onset_date: '2025-06-07'
  severity: Moderate
  outcome: Fatal
  intervention_required: false
- symptom_name: Pruritus
  onset_date: '2025-06-07'
  severity: Mild
  outcome: Not Recovered
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 1
reporting_facility: Garrett-Davis Medical Center
reporter_type: Nurse
notes: Imagine memory hair huge itself side heart. Number father war fish. Total could
  tough in institution everyone listen them.
