<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-2025-306
Date of Submission: 2025-01-06

This report was submitted by a Patient from Johnson-Martinez Medical Center concerning patient ANON-PX-3331. The subject is an adult other with a significant medical history including type 2 diabetes, 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 administered via the Oral route at a dosage of 108mg, initiated on 2024-11-13 for Hypothyroidism and discontinued on 2024-12-21; Amoxicillin (Penicillin antibiotic) administered via the Intravenous route at a dosage of 75mg, initiated on 2024-11-13 for Bacterial infection and discontinued on 2024-12-21.

On approximately 2024-12-15, the patient began to manifest an adverse event. The primary symptoms noted in the clinical log were Vomiting, Nausea, Anaphylaxis. The Vomiting was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Nausea was classified as Life-threatening in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. The Anaphylaxis was classified as Mild in severity. No specific therapeutic intervention was required. The current patient status regarding this symptom is 'Fatal'. 

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: 'Negative dechallenge'. The on-site pharmacist concurred with the assessment during a routine case review. 

Reporter's Narrative Summary: Boy near ability want ever office. Night son high answer under. Century stage task fish senior step.</data>
report_id: ADR-2025-306
report_date: '2025-01-06'
patient_details:
  patient_id: ANON-PX-3331
  gender: Other
  relevant_history:
  - type 2 diabetes
  - hypertension
suspected_drugs:
- drug_name: Levothyroxine
  dosage: 108mg
  route_of_administration: Oral
  start_date: '2024-11-13'
  indication_for_use: Hypothyroidism
  end_date: '2024-12-21'
- drug_name: Amoxicillin
  dosage: 75mg
  route_of_administration: Intravenous
  start_date: '2024-11-13'
  indication_for_use: Bacterial infection
  drug_class: Penicillin antibiotic
  end_date: '2024-12-21'
adverse_reactions:
- symptom_name: Vomiting
  onset_date: '2024-12-15'
  severity: Mild
  outcome: Fatal
  intervention_required: false
- symptom_name: Nausea
  onset_date: '2024-12-15'
  severity: Life-threatening
  outcome: Fatal
  intervention_required: false
- symptom_name: Anaphylaxis
  onset_date: '2024-12-15'
  severity: Mild
  outcome: Fatal
  intervention_required: false
causality_assessment:
  assessment_conclusion: Possible
  dechallenge_rechallenge: Negative dechallenge
  naranjo_score: 4
reporting_facility: Johnson-Martinez Medical Center
reporter_type: Patient
notes: Boy near ability want ever office. Night son high answer under. Century stage
  task fish senior step.
