<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-2025-396
Date of Submission: 2025-04-05

This report was submitted by a Pharmacist from Wilson, Jones and Schaefer Medical Center concerning patient ANON-PX-2020. The subject is a 28-year-old other with a significant medical history including chronic kidney disease, atrial fibrillation, osteoarthritis, hypertension. 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 311mg, initiated on 2025-02-22 for Hypothyroidism and discontinued on 2025-03-31; Ibuprofen (NSAID) administered via the Intramuscular route at a dosage of 423mg, initiated on 2025-02-22 for Pain and inflammation and discontinued on 2025-03-31.

On approximately 2025-03-12, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Somnolence, Hepatotoxicity, Maculopapular Rash, Diarrhea, Anaphylaxis. The Somnolence was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Hepatotoxicity was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovered'. The Maculopapular Rash was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Unknown'. The Diarrhea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Anaphylaxis was classified as Severe 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. A Naranjo score of 4 was calculated, The assessment concluded the relationship was 'Possible'. 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: Affect remember ago question hair plan. Ever kitchen cut local determine fund.</data>
report_id: ADR-2025-396
report_date: '2025-04-05'
patient_details:
  patient_id: ANON-PX-2020
  gender: Other
  relevant_history:
  - chronic kidney disease
  - atrial fibrillation
  - osteoarthritis
  - hypertension
  age_at_reaction: 28
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 311mg
  route_of_administration: Subcutaneous
  start_date: '2025-02-22'
  indication_for_use: Hypothyroidism
  drug_class: Thyroid hormone
  end_date: '2025-03-31'
- drug_name: Ibuprofen
  dosage: 423mg
  route_of_administration: Intramuscular
  start_date: '2025-02-22'
  indication_for_use: Pain and inflammation
  drug_class: NSAID
  end_date: '2025-03-31'
adverse_reactions:
- symptom_name: Somnolence
  onset_date: '2025-03-12'
  severity: Mild
  outcome: Unknown
  intervention_required: false
- symptom_name: Hepatotoxicity
  onset_date: '2025-03-12'
  severity: Life-threatening
  outcome: Recovered
  intervention_required: false
- symptom_name: Maculopapular Rash
  onset_date: '2025-03-12'
  severity: Moderate
  outcome: Unknown
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-03-12'
  severity: Life-threatening
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2025-03-12'
  severity: Severe
  outcome: Unknown
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Not applicable
  naranjo_score: 4
reporting_facility: Wilson, Jones and Schaefer Medical Center
reporter_type: Pharmacist
notes: Affect remember ago question hair plan. Ever kitchen cut local determine fund.
