BEUDAMED
    FDA Adverse Event Injury Summary report: N

    SUNRISE EHR

    MDR report key: 3999615 · Received August 5, 2014

    Report

    Report Number
    MW5037670
    Event Type
    Injury
    Date Received
    August 5, 2014
    Date of Event
    August 1, 2014
    Report Date
    August 4, 2014
    Manufacturer
    ALLSCRIPTS
    Product Code
    LNX
    Adverse Event
    Yes
    Product Problem
    Yes
    Report Source
    Voluntary report
    Reporter Location
    PA, US
    Reporter Occupation
    PHYSICIAN

    Narratives

    Description of Event or Problem · 1

    THE PT WITH CONGESTIVE HEART FAILURE WITH ARRHYTHMIAS WENT FOR EVAL AT ER AFTER INGESTING EXCESS DIURETICS. THE DOCTOR IN THE ER WAS OF THE IMPRESSION THAT THE POTASSIUM WAS NORMAL. THE EHR MDDS DID NOT ADEQUATELY DISCLOSE THAT THE SAMPLE OF BLOOD WAS HEMOLYZED, FALSELY ELEVATING THE POTASSIUM, PROVIDING THE ILLUSION IT WAS NORMAL, WHEN IT WAS SEVERELY LOW. THERE WAS A TINY ASTERISK IN THE CORNER OF THE MDDS GRID, REQUIRING A CLICK TO FIND OUT THAT THE RESULT WAS SPURIOUS.

    Devices

    Seq Brand Generic Product Code Manufacturer Model Lot UDI-DI
    456026 SUNRISE EHR EHR/MDDS LNX ALLSCRIPTS

    Patients

    Seq Age Sex Outcome Treatment
    1 66 YR Life Threatening| O| R