<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-2025-442
Date of Submission: 2025-03-07

This report was submitted by a Patient from Moore-Anderson Medical Center concerning patient ANON-PX-6944. The subject is a 18-year-old male with a significant medical history including 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): Amoxicillin (Penicillin antibiotic) administered via the Topical route at a dosage of 133mg, initiated on 2025-02-25 for Bacterial infection and discontinued on 2025-03-04; Omeprazole (Proton-pump inhibitor) administered via the Subcutaneous route at a dosage of 294mg, initiated on 2025-02-25 for Gastroesophageal reflux disease and discontinued on 2025-03-04.

On approximately 2025-03-03, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Pruritus, Angioedema, Diarrhea, Anaphylaxis, Stevens-Johnson syndrome. The Pruritus was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Angioedema was classified as Severe in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Diarrhea was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Recovering'. The Anaphylaxis was classified as Moderate in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Recovering'. The Stevens-Johnson syndrome was classified as Life-threatening in severity. This necessitated clinical intervention. The current patient status regarding this symptom is 'Fatal'. 

CAUSALITY ASSESSMENT:
An evaluation of causality was performed. The assessment concluded the relationship was 'Probable'. Dechallenge/Rechallenge status was noted as: 'Negative dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: One admit board my thousand wonder. Whole eat down teacher yes that from. Kind despite similar section return.</data>
report_id: ADR-2025-442
report_date: '2025-03-07'
patient_details:
  patient_id: ANON-PX-6944
  gender: Male
  relevant_history:
  - chronic kidney disease
  - seasonal allergies
  age_at_reaction: 18
suspected_drugs:
- drug_name: Amoxicillin
  dosage: 133mg
  route_of_administration: Topical
  start_date: '2025-02-25'
  indication_for_use: Bacterial infection
  drug_class: Penicillin antibiotic
  end_date: '2025-03-04'
- drug_name: Omeprazole
  dosage: 294mg
  route_of_administration: Subcutaneous
  start_date: '2025-02-25'
  indication_for_use: Gastroesophageal reflux disease
  drug_class: Proton-pump inhibitor
  end_date: '2025-03-04'
adverse_reactions:
- symptom_name: Pruritus
  onset_date: '2025-03-03'
  severity: Severe
  outcome: Fatal
  intervention_required: false
- symptom_name: Angioedema
  onset_date: '2025-03-03'
  severity: Severe
  outcome: Recovering
  intervention_required: false
- symptom_name: Diarrhea
  onset_date: '2025-03-03'
  severity: Mild
  outcome: Recovering
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2025-03-03'
  severity: Moderate
  outcome: Recovering
  intervention_required: true
- symptom_name: Stevens-Johnson syndrome
  onset_date: '2025-03-03'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: true
causality_assessment:
  assessment_conclusion: Probable
  dechallenge_rechallenge: Negative dechallenge
reporting_facility: Moore-Anderson Medical Center
reporter_type: Patient
notes: One admit board my thousand wonder. Whole eat down teacher yes that from. Kind
  despite similar section return.
