“…Spontaneous case reports can have value in very limited circumstances, in particular, where an exposure is quite rare and the outcome both rare and distinctive [Shepard, 1991; Carey, 2008]. Two examples where this study design has been helpful include the association between high‐dose, prolonged fluconazole use and a distinctive phenotype [Lopez‐Rangel and Van Allen, 2005], and the association between warfarin exposure and chondrodysplasia punctata [Shaul et al, 1975; Pauli et al, 1976; Collins et al, 1977], both of which were largely identified through case reports [Reprotox, 2008; TERIS (Teratogen Information System), 2008].…”