Immunization

Describes the event of a patient being administered a vaccine or a record of an immunization as reported by a patient, a clinician or another party. Refer to the US Core Immunizations profile.

Schema

Elements

Name	Required	Type	Description
identifier		Identifier[]	Business identifier Details A unique identifier assigned to this immunization record.
status	✓	code	completed | entered-in-error | not-done Details Indicates the current status of the immunization event. Will generally be set to show that the immunization has been completed or not done. This element is labeled as a modifier because the status contains codes that mark the resource as not currently valid.
statusReason		CodeableConcept	Reason not done Details Indicates the reason the immunization event was not performed. This is generally only used for the status of "not-done". The reason for performing the immunization event is captured in reasonCode, not here.
vaccineCode	✓	CodeableConcept	Vaccine product administered Details Vaccine that was administered or was to be administered.
patient	✓	Reference<Patient>	Who was immunized Details The patient who either received or did not receive the immunization.
encounter		Reference<Encounter>	Encounter immunization was part of Details The visit or admission or other contact between patient and health care provider the immunization was performed as part of.
occurrence[x]	✓	dateTime, string	Vaccine administration date Details Date vaccine administered or was to be administered. When immunizations are given a specific date and time should always be known. When immunizations are patient reported, a specific date might not be known. Although partial dates are allowed, an adult patient might not be able to recall the year a childhood immunization was given. An exact date is always preferable, but the use of the String data type is acceptable when an exact date is not known. A small number of vaccines (e.g. live oral typhoid vaccine) are given as a series of patient self-administered dose over a span of time. In cases like this, often, only the first dose (typically a provider supervised dose) is recorded with the occurrence indicating the date/time of the first dose.
recorded		dateTime	When the immunization was first captured in the subject's record Details The date the occurrence of the immunization was first captured in the record - potentially significantly after the occurrence of the event.
primarySource		boolean	Indicates context the data was recorded in Details An indication that the content of the record is based on information from the person who administered the vaccine. This reflects the context under which the data was originally recorded. Reflects the “reliability” of the content.
reportOrigin		CodeableConcept	Indicates the source of a secondarily reported record Details The source of the data when the report of the immunization event is not based on information from the person who administered the vaccine. Should not be populated if primarySource = True, not required even if primarySource = False.
location		Reference<Location>	Where immunization occurred Details The service delivery location where the vaccine administration occurred.
manufacturer		Reference<Organization>	Vaccine manufacturer Details Name of vaccine manufacturer.
lotNumber		string	Vaccine lot number Details Lot number of the vaccine product.
expirationDate		date	Vaccine expiration date Details Date vaccine batch expires.
site		CodeableConcept	Body site vaccine was administered Details Body site where vaccine was administered.
route		CodeableConcept	How vaccine entered body Details The path by which the vaccine product is taken into the body.
doseQuantity		Quantity	Amount of vaccine administered Details The quantity of vaccine product that was administered.
performer		ImmunizationPerformer[]	Who performed event Details Indicates who performed the immunization event.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
function		CodeableConcept	What type of performance was done Details Describes the type of performance (e.g. ordering provider, administering provider, etc.).
actor	✓	Reference< Practitioner | PractitionerRole | Organization >	Individual or organization who was performing Details The practitioner or organization who performed the action. When the individual practitioner who performed the action is known, it is best to send.
note		Annotation[]	Additional immunization notes Details Extra information about the immunization that is not conveyed by the other attributes.
reasonCode		CodeableConcept[]	Why immunization occurred Details Reasons why the vaccine was administered.
reasonReference		Reference< Condition | Observation | DiagnosticReport >[]	Why immunization occurred Details Condition, Observation or DiagnosticReport that supports why the immunization was administered.
isSubpotent		boolean	Dose potency Details Indication if a dose is considered to be subpotent. By default, a dose should be considered to be potent. Typically, the recognition of the dose being sub-potent is retrospective, after the administration (ex. notification of a manufacturer recall after administration). However, in the case of a partial administration (the patient moves unexpectedly and only some of the dose is actually administered), subpotency may be recognized immediately, but it is still important to record the event.
subpotentReason		CodeableConcept[]	Reason for being subpotent Details Reason why a dose is considered to be subpotent.
education		ImmunizationEducation[]	Educational material presented to patient Details Educational material presented to the patient (or guardian) at the time of vaccine administration.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
documentType		string	Educational material document identifier Details Identifier of the material presented to the patient.
reference		uri	Educational material reference pointer Details Reference pointer to the educational material given to the patient if the information was on line.
publicationDate		dateTime	Educational material publication date Details Date the educational material was published.
presentationDate		dateTime	Educational material presentation date Details Date the educational material was given to the patient.
programEligibility		CodeableConcept[]	Patient eligibility for a vaccination program Details Indicates a patient's eligibility for a funding program.
fundingSource		CodeableConcept	Funding source for the vaccine Details Indicates the source of the vaccine actually administered. This may be different than the patient eligibility (e.g. the patient may be eligible for a publically purchased vaccine but due to inventory issues, vaccine purchased with private funds was actually administered).
reaction		ImmunizationReaction[]	Details of a reaction that follows immunization Details Categorical data indicating that an adverse event is associated in time to an immunization. A reaction may be an indication of an allergy or intolerance and, if this is determined to be the case, it should be recorded as a new AllergyIntolerance resource instance as most systems will not query against past Immunization.reaction elements.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
date		dateTime	When reaction started Details Date of reaction to the immunization.
detail		Reference<Observation>	Additional information on reaction Details Details of the reaction.
reported		boolean	Indicates self-reported reaction Details Self-reported indicator.
protocolApplied		ImmunizationProtocolApplied[]	Protocol followed by the provider Details The protocol (set of recommendations) being followed by the provider who administered the dose.
id		string	Unique id for inter-element referencing Details Unique id for the element within a resource (for internal references). This may be any string value that does not contain spaces.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the element. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored even if unrecognized Details May be used to represent additional information that is not part of the basic definition of the element and that modifies the understanding of the element in which it is contained and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
series		string	Name of vaccine series Details One possible path to achieve presumed immunity against a disease - within the context of an authority.
authority		Reference<Organization>	Who is responsible for publishing the recommendations Details Indicates the authority who published the protocol (e.g. ACIP) that is being followed.
targetDisease		CodeableConcept[]	Vaccine preventatable disease being targetted Details The vaccine preventable disease the dose is being administered against.
doseNumber[x]	✓	positiveInt, string	Dose number within series Details Nominal position in a series. The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).
seriesDoses[x]		positiveInt, string	Recommended number of doses for immunity Details The recommended number of doses to achieve immunity. The use of an integer is preferred if known. A string should only be used in cases where an integer is not available (such as when documenting a recurring booster dose).

Search Parameters

Name	Type	Description	Expression
date	date	Vaccination (non)-Administration Date	Immunization.occurrence
identifier	token	Business identifier	Immunization.identifier
patient	reference	The patient for the vaccination record	Immunization.patient
location	reference	The service delivery location or facility in which the vaccine was / was to be administered	Immunization.location
lot-number	string	Vaccine Lot Number	Immunization.lotNumber
manufacturer	reference	Vaccine Manufacturer	Immunization.manufacturer
performer	reference	The practitioner or organization who played a role in the vaccination	Immunization.performer.actor
reaction	reference	Additional information on reaction	Immunization.reaction.detail
reaction-date	date	When reaction started	Immunization.reaction.date
reason-code	token	Reason why the vaccine was administered	Immunization.reasonCode
reason-reference	reference	Why immunization occurred	Immunization.reasonReference
series	string	The series being followed by the provider	Immunization.protocolApplied.series
status	token	Immunization event status	Immunization.status
status-reason	token	Reason why the vaccine was not administered	Immunization.statusReason
target-disease	token	The target disease the dose is being administered against	Immunization.protocolApplied.targetDisease
vaccine-code	token	Vaccine Product Administered	Immunization.vaccineCode

Inherited Elements

Name	Required	Type	Description
id		string	Logical id of this artifact Details The logical id of the resource, as used in the URL for the resource. Once assigned, this value never changes. The only time that a resource does not have an id is when it is being submitted to the server using a create operation.
meta		Meta	Metadata about the resource Details The metadata about the resource. This is content that is maintained by the infrastructure. Changes to the content might not always be associated with version changes to the resource.
implicitRules		uri	A set of rules under which this content was created Details A reference to a set of rules that were followed when the resource was constructed, and which must be understood when processing the content. Often, this is a reference to an implementation guide that defines the special rules along with other profiles etc. Asserting this rule set restricts the content to be only understood by a limited set of trading partners. This inherently limits the usefulness of the data in the long term. However, the existing health eco-system is highly fractured, and not yet ready to define, collect, and exchange data in a generally computable sense. Wherever possible, implementers and/or specification writers should avoid using this element. Often, when used, the URL is a reference to an implementation guide that defines these special rules as part of it's narrative along with other profiles, value sets, etc.
language		code	Language of the resource content Details The base language in which the resource is written. Language is provided to support indexing and accessibility (typically, services such as text to speech use the language tag). The html language tag in the narrative applies to the narrative. The language tag on the resource may be used to specify the language of other presentations generated from the data in the resource. Not all the content has to be in the base language. The Resource.language should not be assumed to apply to the narrative automatically. If a language is specified, it should it also be specified on the div element in the html (see rules in HTML5 for information about the relationship between xml:lang and the html lang attribute).
text		Narrative	Text summary of the resource, for human interpretation Details A human-readable narrative that contains a summary of the resource and can be used to represent the content of the resource to a human. The narrative need not encode all the structured data, but is required to contain sufficient detail to make it "clinically safe" for a human to just read the narrative. Resource definitions may define what content should be represented in the narrative to ensure clinical safety. Contained resources do not have narrative. Resources that are not contained SHOULD have a narrative. In some cases, a resource may only have text with little or no additional discrete data (as long as all minOccurs=1 elements are satisfied). This may be necessary for data from legacy systems where information is captured as a "text blob" or where text is additionally entered raw or narrated and encoded information is added later.
contained		Resource[]	Contained, inline Resources Details These resources do not have an independent existence apart from the resource that contains them - they cannot be identified independently, and nor can they have their own independent transaction scope. This should never be done when the content can be identified properly, as once identification is lost, it is extremely difficult (and context dependent) to restore it again. Contained resources may have profiles and tags In their meta elements, but SHALL NOT have security labels.
extension		Extension[]	Additional content defined by implementations Details May be used to represent additional information that is not part of the basic definition of the resource. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer can define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.
modifierExtension		Extension[]	Extensions that cannot be ignored Details May be used to represent additional information that is not part of the basic definition of the resource and that modifies the understanding of the element that contains it and/or the understanding of the containing element's descendants. Usually modifier elements provide negation or qualification. To make the use of extensions safe and manageable, there is a strict set of governance applied to the definition and use of extensions. Though any implementer is allowed to define an extension, there is a set of requirements that SHALL be met as part of the definition of the extension. Applications processing a resource are required to check for modifier extensions. Modifier extensions SHALL NOT change the meaning of any elements on Resource or DomainResource (including cannot change the meaning of modifierExtension itself). There can be no stigma associated with the use of extensions by any application, project, or standard - regardless of the institution or jurisdiction that uses or defines the extensions. The use of extensions is what allows the FHIR specification to retain a core level of simplicity for everyone.

Usage

The Immunization resource is intended to cover the recording of current and historical administration of vaccines to patients across all healthcare disciplines in all care settings and all regions. This includes immunization of both humans and animals but does not include the administration of non-vaccine agents, even those that may have or claim to have immunological effects. While the terms "immunization" and "vaccination" are not clinically identical, for the purposes of the FHIR resources, the terms are used synonymously.

Additionally, the Immunization resource is expected to cover key concepts related to the creation, revision and querying of a patient's immunization history. This resource - through consultation with the Public Health work group - is believed to meet key use cases and information requirements as defined in the existing HL7 v2 immunization implementation guide, HL7 v3 POIZ domain and Immunization Domain Analysis Model.

Relationships

Administration of vaccines is intended to be handled using the Immunization resource. MedicationAdministration is intended for tracking the administration of non-vaccine medications. Some systems treat immunizations in the same way as any other medication administration. Such systems SHOULD use an immunization resource to represent these. If systems need to use a MedicationAdministration resource to capture vaccinations for workflow or other reasons, they SHOULD also expose an equivalent Immunization instance.

Immunization.reaction may be an indication of an allergy or intolerance. If this is deemed to be the case, a separate AllergyIntolerance resource instance should be created to indicate it, as most systems will not query against past Immunization.reaction.

Referenced By

• AdverseEvent
• ChargeItem
• ImmunizationEvaluation
• ImmunizationRecommendation
• Observation