<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-2024-328
Date of Submission: 2024-08-18

This report was submitted by a Pharmacist from Graham-Henderson Medical Center concerning patient ANON-PX-8317. The subject is a 49-year-old female with a significant medical history including hypertension, coronary artery disease, chronic kidney disease. 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 Intramuscular route at a dosage of 182mg, initiated on 2024-07-05 for Thromboembolism prevention and discontinued on 2024-08-13; Levothyroxine administered via the Intravenous route at a dosage of 169mg, initiated on 2024-07-05 for Hypothyroidism and discontinued on 2024-08-13.

On approximately 2024-08-12, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Maculopapular Rash, Nausea, Diarrhea. The Maculopapular Rash was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Nausea was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. A Naranjo score of 5 was calculated, 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: Discussion less thousand fast early so. Capital cut American quickly member home during.</data>
report_id: ADR-2024-328
report_date: '2024-08-18'
patient_details:
  patient_id: ANON-PX-8317
  gender: Female
  relevant_history:
  - hypertension
  - coronary artery disease
  - chronic kidney disease
  age_at_reaction: 49
suspected_drugs:
- drug_name: Warfarin
  dosage: 182mg
  route_of_administration: Intramuscular
  start_date: '2024-07-05'
  indication_for_use: Thromboembolism prevention
  drug_class: Anticoagulant
  end_date: '2024-08-13'
- drug_name: Levothyroxine
  dosage: 169mg
  route_of_administration: Intravenous
  start_date: '2024-07-05'
  indication_for_use: Hypothyroidism
  end_date: '2024-08-13'
adverse_reactions:
- symptom_name: Maculopapular Rash
  onset_date: '2024-08-12'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2024-08-12'
  severity: Mild
  outcome: Recovering
  intervention_required: true
- symptom_name: Diarrhea
  onset_date: '2024-08-12'
  severity: Mild
  outcome: Fatal
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Positive rechallenge
  naranjo_score: 5
reporting_facility: Graham-Henderson Medical Center
reporter_type: Pharmacist
notes: Discussion less thousand fast early so. Capital cut American quickly member
  home during.
