<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-2025-414
Date of Submission: 2025-06-29

This report was submitted by a Patient from Allison, Jensen and Costa Medical Center concerning patient ANON-PX-9699. The subject is a 37-year-old other with a significant medical history including seasonal allergies, atrial fibrillation, chronic kidney disease, anxiety. 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): Omeprazole (Proton-pump inhibitor) administered via the Subcutaneous route at a dosage of 51mg, initiated on 2025-06-19 for Gastroesophageal reflux disease and discontinued on 2025-06-25.

On approximately 2025-06-24, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Diarrhea, Pruritus, Headache, Maculopapular Rash. The Diarrhea was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed later and advised trip. The current patient status regarding this symptom is 'Recovered'. The Pruritus was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed could and advised risk. The current patient status regarding this symptom is 'Recovered'. The Headache was classified as Mild in severity. This necessitated clinical intervention. The documented action was: Prescribed young and advised herself. The current patient status regarding this symptom is 'Fatal'. The Maculopapular Rash was classified as Moderate in severity. This necessitated clinical intervention. The documented action was: Prescribed her and advised time. The current patient status regarding this symptom is 'Not Recovered'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. 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. 

</data>
report_id: ADR-2025-414
report_date: '2025-06-29'
patient_details:
  patient_id: ANON-PX-9699
  gender: Other
  relevant_history:
  - seasonal allergies
  - atrial fibrillation
  - chronic kidney disease
  - anxiety
  age_at_reaction: 37
suspected_drugs:
- drug_name: Omeprazole
  dosage: 51mg
  route_of_administration: Subcutaneous
  start_date: '2025-06-19'
  indication_for_use: Gastroesophageal reflux disease
  drug_class: Proton-pump inhibitor
  end_date: '2025-06-25'
adverse_reactions:
- symptom_name: Diarrhea
  onset_date: '2025-06-24'
  severity: Mild
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed later and advised trip.
- symptom_name: Pruritus
  onset_date: '2025-06-24'
  severity: Mild
  outcome: Recovered
  intervention_required: true
  intervention_details: Prescribed could and advised risk.
- symptom_name: Headache
  onset_date: '2025-06-24'
  severity: Mild
  outcome: Fatal
  intervention_required: true
  intervention_details: Prescribed young and advised herself.
- symptom_name: Maculopapular Rash
  onset_date: '2025-06-24'
  severity: Moderate
  outcome: Not Recovered
  intervention_required: true
  intervention_details: Prescribed her and advised time.
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Rechallenge not performed
reporting_facility: Allison, Jensen and Costa Medical Center
reporter_type: Patient
