<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-2025-765
Date of Submission: 2025-07-12

This report was submitted by a Nurse from Melendez, Martin and Payne Medical Center concerning patient ANON-PX-3527. The subject is a 89-year-old female with a significant medical history including asthma, chronic kidney disease, seasonal allergies. 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): Lisinopril (ACE inhibitor) administered via the Intravenous route at a dosage of 28mg, initiated on 2025-06-12 for Hypertension and discontinued on 2025-07-09.

On approximately 2025-07-09, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Anaphylaxis, Nausea, Maculopapular Rash, Somnolence. The Anaphylaxis was classified as Mild in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Not Recovered'. The Maculopapular Rash was classified as Moderate in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Somnolence was classified as Severe 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 8 was calculated, The assessment concluded the relationship was 'Probable'. Dechallenge/Rechallenge status was noted as: 'Rechallenge not performed'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Building such quickly deal. Cultural science scientist pressure.</data>
report_id: ADR-2025-765
report_date: '2025-07-12'
patient_details:
  patient_id: ANON-PX-3527
  gender: Female
  relevant_history:
  - asthma
  - chronic kidney disease
  - seasonal allergies
  age_at_reaction: 89
suspected_drugs:
- drug_name: Lisinopril
  dosage: 28mg
  route_of_administration: Intravenous
  start_date: '2025-06-12'
  indication_for_use: Hypertension
  drug_class: ACE inhibitor
  end_date: '2025-07-09'
adverse_reactions:
- symptom_name: Anaphylaxis
  onset_date: '2025-07-09'
  severity: Mild
  outcome: Fatal
  intervention_required: true
- symptom_name: Nausea
  onset_date: '2025-07-09'
  severity: Mild
  outcome: Not Recovered
  intervention_required: false
- symptom_name: Maculopapular Rash
  onset_date: '2025-07-09'
  severity: Moderate
  outcome: Recovering
  intervention_required: false
- symptom_name: Somnolence
  onset_date: '2025-07-09'
  severity: Severe
  outcome: Fatal
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Rechallenge not performed
  naranjo_score: 8
reporting_facility: Melendez, Martin and Payne Medical Center
reporter_type: Nurse
notes: Building such quickly deal. Cultural science scientist pressure.
