<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-2024-542
Date of Submission: 2024-11-24

This report was submitted by a Pharmacist from Bell LLC Medical Center concerning patient ANON-PX-9207. The subject is a 90-year-old other with a significant medical history including asthma, 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 Topical route at a dosage of 317mg, initiated on 2024-10-21 for Hypothyroidism and discontinued on 2024-11-13; Lisinopril (ACE inhibitor) administered via the Intramuscular route at a dosage of 281mg, initiated on 2024-10-21 for Hypertension and discontinued on 2024-11-13.

On approximately 2024-11-03, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Vomiting, Hepatotoxicity, Somnolence, Angioedema. The Pruritus was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Vomiting was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed short and advised effect. The current patient status regarding this symptom is 'Recovering'. The Hepatotoxicity was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Somnolence was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed around and advised wall. The current patient status regarding this symptom is 'Fatal'. The Angioedema was classified as Mild in severity. No specific therapeutic intervention was required. 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: 'Positive rechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Page radio phone away between number stand way. Material girl hope give major hope. Item glass end. Identify already sound sport public quite month.</data>
report_id: ADR-2024-542
report_date: '2024-11-24'
patient_details:
  patient_id: ANON-PX-9207
  gender: Other
  relevant_history:
  - asthma
  - atrial fibrillation
  age_at_reaction: 90
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 317mg
  route_of_administration: Topical
  start_date: '2024-10-21'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2024-11-13'
- drug_name: Lisinopril
  dosage: 281mg
  route_of_administration: Intramuscular
  start_date: '2024-10-21'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2024-11-13'
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2024-11-03'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Vomiting
  onset_date: '2024-11-03'
  severity: Moderate
  outcome: Recovering
  intervention_required: true
  intervention_details: Prescribed short and advised effect.
- symptom_name: Hepatotoxicity
  onset_date: '2024-11-03'
  severity: Severe
  outcome: Unknown
  intervention_required: false
- symptom_name: Somnolence
  onset_date: '2024-11-03'
  severity: Moderate
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed around and advised wall.
- symptom_name: Angioedema
  onset_date: '2024-11-03'
  severity: Mild
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Positive rechallenge
reporting_facility: Bell LLC Medical Center
reporter_type: Pharmacist
notes: Page radio phone away between number stand way. Material girl hope give major
  hope. Item glass end. Identify already sound sport public quite month.
