Immunization status


Parameter Case Report Form and Response Options

Immunization status
Influenza
Pneumococcal
BCG
COVID-19
Other

This profile of a FHIR Immunization is closely aligned to the Immunization-profile of the MIO Impfpass by Kassenärztliche Bundesvereinigung (KBV).

Use the Immunization.protocolApplied.targetDisease element to code the response options. This is vaccine preventatable disease being targetted.

Immunization.occurrence[x] shall cover the date when the immunization was last administered.

Immunization.vaccineCode can contain a code for the vaccine product administered. In case there is no information on vaccinations or no vaccnations are known, use the options from the absentOrUnknownImmunizations slice.

SNOMED provides codes for Covid-19 vaccinations which are included in the MIO Impfpass ValueSet to be used on Immunization.vaccineCode.coding:snomed. Branded products are out of scope of the International Edition of SNOMED. Therefore, the vaccine products must be mapped to the abstract codes as below:


Vaccine branded product SNOMED
Co­mir­na­ty® BioNTech/Pfizer 1119349007 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)|
COVID-19 Vaccine Moderna® 1119349007 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)|
Va­x­ze­vria® Astra­Zene­ca 29061000087103 |Vaccine product containing only recombinant non-replicating viral vector encoding Severe acute respiratory syndrome coronavirus 2 spike protein (medicinal product)|
Janssen® Johnson & Johnson 29061000087103 |Vaccine product containing only recombinant non-replicating viral vector encoding Severe acute respiratory syndrome coronavirus 2 spike protein (medicinal product)|
Nuvaxovid® Novavax 1162643001 |Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 recombinant spike protein antigen (medicinal product)|
Sputnik V® / Gam-COVID-Vac® Gamaleya NRCEM 29061000087103 |Vaccine product containing only recombinant non-replicating viral vector encoding Severe acute respiratory syndrome coronavirus 2 spike protein (medicinal product)|
CoronaVac® SinoVac Biotech 1157024006 |Vaccine product containing only inactivated whole Severe acute respiratory syndrome coronavirus 2 antigen (medicinal product)|

Profile - Immunization

Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/immunization

Snapshot

idΣ0..1string
metaΣ0..1Meta
implicitRulesΣ ?!0..1uri
language0..1codeBinding
text0..1Narrative
contained0..*Resource
extensionI0..*Extension
modifierExtension?! I0..*Extension
identifier0..*Identifier
statusΣ ?!1..1codeBinding
statusReason0..1CodeableConcept
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
id0..1string
extensionI0..*Extension
systemΣ1..1uriFixed Value
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
patientS Σ I1..1Reference(Patient)
encounterI0..1Reference(Encounter)
occurrenceStringstring
occurrenceDateTimeS Σ0..1dateTime
recorded0..1dateTime
primarySourceΣ0..1boolean
reportOrigin0..1CodeableConcept
locationI0..1Reference(Location)
manufacturerI0..1Reference(Organization)
lotNumber0..1string
expirationDate0..1date
site0..1CodeableConcept
route0..1CodeableConcept
doseQuantityI0..1SimpleQuantity
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
functionΣ0..1CodeableConceptBinding
actorΣ I1..1Reference(Practitioner | PractitionerRole | Organization)
noteΣ0..*Annotation
reasonCode0..*CodeableConcept
reasonReferenceI0..*Reference(Condition | Observation | DiagnosticReport)
isSubpotentΣ ?!0..1boolean
subpotentReason0..*CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
documentType0..1string
reference0..1uri
publicationDate0..1dateTime
presentationDate0..1dateTime
programEligibility0..*CodeableConcept
fundingSource0..1CodeableConcept
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
date0..1dateTime
detailI0..1Reference(Observation)
reported0..1boolean
id0..1string
extensionI0..*Extension
modifierExtensionΣ ?! I0..*Extension
series0..1string
authorityI0..1Reference(Organization)
id0..1string
extensionI0..*Extension
id0..1string
extensionI0..*Extension
systemΣ1..1uri
versionΣ0..1string
codeΣ1..1code
displayΣ0..1string
userSelectedΣ0..1boolean
textΣ0..1string
doseNumberPositiveIntpositiveInt
doseNumberStringstring
seriesDosesPositiveIntpositiveInt
seriesDosesStringstring


ValueSets

The targetDisease value set is defined by KBV as part of the MIO Impfpass. The vaccine codes also originate from the MIO Impfpass: vaccineCode. Here a replica of the value set is used to add terminology server validation support for postcoordinated SNOMED expressions. The ATC vaccine codes below are identical to KBV MIO Impfpass but use an updated URL for the ATC code system.


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/vaccines-atc

ValueSet 'VaccinesATC'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

This value set contains ATC codes for vaccines

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • Include codes from Atc where concept DescendentOf J07
  • The following codes from system: Atc

    CodeDisplay
    J07ARTyphus (exanthematicus)-Impfstoff
    J07AR01Typhus exanthematicus, inaktiviert, ganze Zelle
    J07ACMilzbrand-Impfstoffe
    J07AC01Anthrax-Antigen
    J07ADBrucellose-Impfstoffe
    J07AD01Brucella-Antigen
    J07AECholera-Impfstoffe
    J07AE01Cholera, inaktiviert, ganze Zelle
    J07AE02Cholera, lebend abgeschwächt
    J07AE51Cholera, Kombinationen mit Typhus-Impfstoff, inaktiviert, ganze Zelle
    J07AFDiphtherie-Impfstoffe
    J07AF01Diphtherie-Toxoid
    J07AGHaemophilus influenzae B-Impfstoffe
    J07AG01Haemophilus influenzae B, gereinigtes Antigen konjugiert
    J07AG51Haemophilus influenzae B, Kombinationen mit Toxoiden
    J07AG52Haemophilus influenzae B, Kombinationen mit Pertussis und Toxoiden
    J07AG53Haemophilus influenzae B, Kombinationen mit Meningokokken C, konjugiert
    J07AHMeningokokken-Impfstoffe
    J07AH01Meningokokken A, gereinigtes Polysaccharid-Antigen
    J07AH02Andere Meningokokken monovalent, gereinigtes Polysaccharid-Antigen
    J07AH03Meningokokken bivalent (A, C), gereinigtes Polysaccharid-Antigen
    J07AH04Meningokokken tetravalent (A, C, Y, W-135), gereinigtes Polysaccharid-Antigen
    J07AH05Andere Meningokokken polyvalent, gereinigtes Polysaccharid-Antigen
    J07AH06Meningokokken B, äußere Vesikelmembran-Impfstoff
    J07AH07Meningokokken C, gereinigtes Polysaccharid-Antigen, konjugiert
    J07AH08Meningokokken tetravalent (A, C, Y, W-135), gereinigtes Polysaccharid-Antigen, konjugiert
    J07AH09Meningokokken B, Multikomponenten-Impfstoff
    J07AH10Meningokokken A, gereinigtes Polysaccharid-Antigen, konjugiert
    J07AJPertussis-Impfstoffe
    J07AJ01Pertussis, inaktiviert, ganze Zelle
    J07AJ02Pertussis, gereinigtes Antigen
    J07AJ51Pertussis, inaktiviert, ganze Zelle, Kombinationen mit Toxoiden
    J07AJ52Pertussis, gereinigtes Antigen, Kombinationen mit Toxoiden
    J07AKPest-Impfstoffe
    J07AK01Pest, inaktiviert, ganze Zelle
    J07ALPneumokokken-Impfstoffe
    J07AL01Pneumokokken, gereinigtes Polysaccharid-Antigen
    J07AL02Pneumokokken, gereinigtes Polysaccharid-Antigen, konjugiert
    J07AL52Pneumokokken, gereinigtes Polysaccharid-Antigen und Haemophilus influenzae B, konjugiert
    J07AMTetanus-Impfstoffe
    J07AM01Tetanus-Toxoid
    J07AM51Tetanus-Toxoid, Kombinationen mit Diphtherie-Toxoid
    J07AM52Tetanus-Toxoid, Kombinationen mit Tetanus-Immunglobulin
    J07ANTuberkulose-Impfstoffe
    J07AN01Tuberkulose, lebend abgeschwächt
    J07APTyphus-Impfstoffe
    J07AP01Typhus, oral, lebend abgeschwächt
    J07AP02Typhus, inaktiviert, ganze Zelle
    J07AP03Typhus, gereinigtes Polysaccharid-Antigen
    J07AP10Typhus, Kombinationen mit Paratyphustypen
    J07BAEncephalitis-Impfstoffe
    J07BA01FSME, inaktiviert, ganzes Virus
    J07BA02Encephalitis, japanische, inaktiviert, ganzes Virus
    J07BA03Encephalitis, japanische, lebend abgeschwächt
    J07BBInfluenza-Impfstoffe
    J07BB01Influenza, inaktiviert, ganzes Virus
    J07BB02Influenza, inaktiviert, Spaltvirus oder Oberflächenantigen
    J07BB03Influenza, lebend abgeschwächt
    J07BCHepatitis-Impfstoffe
    J07BC01Hepatitis B, gereinigtes Antigen
    J07BC02Hepatitis A, inaktiviert, ganzes Virus
    J07BC03Hepatitis A, gereinigtes Antigen
    J07BC20Kombinationen
    J07BDMasern-Impfstoffe
    J07BD01Masern, lebend abgeschwächt
    J07BD51Masern, Kombinationen mit Mumps, lebend abgeschwächt
    J07BD52Masern, Kombinationen mit Mumps und Röteln, lebend abgeschwächt
    J07BD53Masern, Kombinationen mit Röteln, lebend abgeschwächt
    J07BD54Masern, Kombinationen mit Mumps, Röteln und Varicella, lebend abgeschwächt
    J07BEMumps-Impfstoffe
    J07BE01Mumps, lebend abgeschwächt
    J07BFPoliomyelitis-Impfstoffe
    J07BF01Poliomyelitis, oral, monovalent, lebend abgeschwächt
    J07BF02Poliomyelitis, oral, trivalent, lebend abgeschwächt
    J07BF03Poliomyelitis, trivalent, inaktiviert, ganzes Virus
    J07BF04Poliomyelitis, oral, bivalent, lebend abgeschwächt
    J07BGTollwut-Impfstoffe
    J07BG01Tollwut, inaktiviert, ganzes Virus
    J07BHRotavirus-Diarrhoe-Impfstoffe
    J07BH01Rotavirus, lebend abgeschwächt
    J07BH02Rotavirus, pentavalent, lebend, Reassortanten
    J07BJRöteln-Impfstoffe
    J07BJ01Röteln, lebend abgeschwächt
    J07BJ51Röteln, Kombinationen mit Mumps, lebend abgeschwächt
    J07BKVaricella Zoster Impfstoffe
    J07BK01Varicella, lebend abgeschwächt
    J07BK02Zoster Virus, lebend abgeschwächt
    J07BK03Zoster Virus, gereinigtes Antigen
    J07BLGelbfieber-Impfstoffe
    J07BL01Gelbfieber, lebend abgeschwächt
    J07BMPapillomvirus-Impfstoffe
    J07BM01Humaner-Papillomvirus-Impfstoff (Typen 6,11,16,18)
    J07BM02Humaner-Papillomvirus-Impfstoff (Typen 16,18)
    J07BM03Humaner-Papillomvirus-Impfstoff (Typen 6,11,16,18,31,33,45,52,58)
    J07BXAndere virale Impfstoffe
    J07BX01Pocken-Impfstoff, lebend, modifiziert
    J07BX03Covid-19-Impfstoffe
    J07CABakterielle und virale Impfstoffe, kombiniert
    J07CA01Diphtherie-Poliomyelitis-Tetanus
    J07CA02Diphtherie-Pertussis-Poliomyelitis-Tetanus
    J07CA03Diphtherie-Röteln-Tetanus
    J07CA04Haemophilus influenzae B und Poliomyelitis
    J07CA05Diphtherie-Hepatitis B-Pertussis-Tetanus
    J07CA06Diphtherie-Haemophilus influenzae B-Pertussis-Poliomyelitis-Tetanus
    J07CA07Diphtherie-Hepatitis B-Tetanus
    J07CA08Haemophilus influenzae B und Hepatitis B
    J07CA09Diphtherie-Haemophilus influenzae B-Pertussis-Poliomyelitis-Tetanus-Hepatitis B
    J07CA10Typhus-Hepatitis A
    J07CA11Diphtherie-Haemophilus influenzae B-Pertussis-Tetanus-Hepatitis B
    J07CA12Diphtherie-Pertussis-Poliomyelitis-Tetanus-Hepatitis B
    J07CA13Diphtherie-Haemophilus influenzae B-Pertussis-Tetanus-Hepatitis B-Meningokokken A + C
  • Include codes from Atc where concept DescendentOf J07


Canonical: https://www.netzwerk-universitaetsmedizin.de/fhir/ValueSet/vaccines-snomed

ValueSet 'VaccinesSNOMED'

Version1.0.6
Published byBerlin Institute of Health at Charité (BIH)
StatusActive
ExperimentalFalse

This value set contains SNOMED codes for vaccines

Contact Information

Website: https://www.bihealth.org/en/re...

This value set includes codes from the following code systems:

  • The following codes from system: SNOMED_CT

    CodeDisplay
    1119305005Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 antigen (medicinal product)
    1119349007Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)
    871875004Vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae antigens (medicinal product)
    787859002Vaccine product (medicinal product)
    37146000Typhus vaccine (product)
    2221000221107Vaccine product containing only live attenuated Human alphaherpesvirus 3 antigen (medicinal product)
    836498007+836388000Vaccine product containing Mumps orthorubulavirus antigen (medicinal product) + Vaccine product containing Rubella virus antigen (medicinal product)
    871729003+836380007+601000221108+863911006+836374004+871871008Vaccine product containing only Corynebacterium diphtheriae antigen (medicinal product) + Vaccine product containing Haemophilus influenzae type B antigen (medicinal product) + Vaccine product containing Bordetella pertussis antigen (medicinal product) + Vaccine product containing Clostridium tetani antigen (medicinal product) + Vaccine product containing Hepatitis B virus antigen (medicinal product) + Vaccine product containing only Neisseria meningitidis serogroup A and C antigens (medicinal product)
    871891001Vaccine product containing only acellular Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae and Hepatitis B virus and inactivated whole Human poliovirus antigens (medicinal product)
    871729003+836380007+601000221108+863911006+836374004Vaccine product containing only Corynebacterium diphtheriae antigen (medicinal product) + Vaccine product containing Haemophilus influenzae type B antigen (medicinal product) + Vaccine product containing Bordetella pertussis antigen (medicinal product) + Vaccine product containing Clostridium tetani antigen (medicinal product) + Vaccine product containing Hepatitis B virus antigen (medicinal product)
    871804001Vaccine product containing only Hepatitis A virus and Salmonella enterica subspecies enterica serovar Typhi antigens (medicinal product)
    871895005Vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae and Haemophilus influenzae type B and Hepatitis B virus and Human poliovirus antigens (medicinal product)
    871806004Vaccine product containing only Haemophilus influenzae type B and Hepatitis B virus antigens (medicinal product)
    871729003+836374004+863911006Vaccine product containing only Corynebacterium diphtheriae antigen (medicinal product) + Vaccine product containing Hepatitis B virus antigen (medicinal product) + Vaccine product containing Clostridium tetani antigen (medicinal product)
    871887006Vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae and Haemophilus influenzae type B and Human poliovirus antigens (medicinal product)
    863911006+836374004+601000221108+836381006Vaccine product containing Clostridium tetani antigen (medicinal product) + Vaccine product containing Hepatitis B virus antigen (medicinal product) + Vaccine product containing Bordetella pertussis antigen (medicinal product) + Vaccine product containing Corynebacterium diphtheriae antigen (medicinal product)
    836380007+1031000221108Vaccine product containing Haemophilus influenzae type B antigen (medicinal product) + Vaccine product containing Human poliovirus antigen (medicinal product)
    871729003+836388000+863911006Vaccine product containing only Corynebacterium diphtheriae antigen (medicinal product) + Vaccine product containing Rubella virus antigen (medicinal product) + Vaccine product containing Clostridium tetani antigen (medicinal product)
    871878002Vaccine product containing only Bordetella pertussis and Clostridium tetani and Corynebacterium diphtheriae and Human poliovirus antigens (medicinal product)
    871837004Vaccine product containing only Clostridium tetani and Corynebacterium diphtheriae and Human poliovirus antigens (medicinal product)
    871908002Vaccine product containing only Human alphaherpesvirus 3 and Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (medicinal product)
    836382004+836388000Vaccine product containing Measles morbillivirus antigen (medicinal product) + Vaccine product containing Rubella virus antigen (medicinal product)
    871831003Vaccine product containing only Measles morbillivirus and Mumps orthorubulavirus and Rubella virus antigens (medicinal product)
    836498007+836382004Vaccine product containing Mumps orthorubulavirus antigen (medicinal product) + Vaccine product containing Measles morbillivirus antigen (medicinal product)
    871803007Vaccine product containing only Hepatitis A and Hepatitis B virus antigens (medicinal product)
    871826000Vaccine product containing only Clostridium tetani and Corynebacterium diphtheriae antigens (medicinal product)
    836398006+836380007Vaccine product containing Streptococcus pneumoniae antigen (medicinal product) + Vaccine product containing Haemophilus influenzae type B antigen (medicinal product)
    836500008Vaccine product containing only Haemophilus influenzae type B and Neisseria meningitidis serogroup C antigens (medicinal product)
    836380007+601000221108Vaccine product containing Haemophilus influenzae type B antigen (medicinal product) + Vaccine product containing Bordetella pertussis antigen (medicinal product)
    836383009+836390004Vaccine product containing Vibrio cholerae antigen (medicinal product) + Vaccine product containing Salmonella enterica subspecies enterica serovar Typhi antigen (medicinal product)
    836378001Vaccine product containing Japanese encephalitis virus antigen (medicinal product)
    836403007Vaccine product containing Tick-borne encephalitis virus antigen (medicinal product)
    871738001Vaccine product containing only live attenuated Mumps orthorubulavirus antigen (medicinal product)
    1031000221108Vaccine product containing Human poliovirus antigen (medicinal product)
    836387005Vaccine product containing Rotavirus antigen (medicinal product)
    836393002Vaccine product containing Rabies lyssavirus antigen (medicinal product)
    836495005Vaccine product containing Human alphaherpesvirus 3 antigen (medicinal product)
    836389008Vaccine product containing Vaccinia virus antigen (medicinal product)
    836379009Vaccine product containing Human papillomavirus antigen (medicinal product)
    836385002Vaccine product containing Yellow fever virus antigen (medicinal product)
    836388000Vaccine product containing Rubella virus antigen (medicinal product)
    836382004Vaccine product containing Measles morbillivirus antigen (medicinal product)
    836375003Vaccine product containing Hepatitis A virus antigen (medicinal product)
    836374004Vaccine product containing Hepatitis B virus antigen (medicinal product)
    836377006Vaccine product containing Influenza virus antigen (medicinal product)
    836390004Vaccine product containing Salmonella enterica subspecies enterica serovar Typhi antigen (medicinal product)
    836402002Vaccine product containing live attenuated Mycobacterium bovis antigen (medicinal product)
    863911006Vaccine product containing Clostridium tetani antigen (medicinal product)
    836398006Vaccine product containing Streptococcus pneumoniae antigen (medicinal product)
    840549009Vaccine product containing Yersinia pestis antigen (medicinal product)
    601000221108Vaccine product containing Bordetella pertussis antigen (medicinal product)
    836401009Vaccine product containing Neisseria meningitidis antigen (medicinal product)
    836380007Vaccine product containing Haemophilus influenzae type B antigen (medicinal product)
    836381006Vaccine product containing Corynebacterium diphtheriae antigen (medicinal product)
    836383009Vaccine product containing Vibrio cholerae antigen (medicinal product)
    836384003Vaccine product containing Bacillus anthracis antigen (medicinal product)


Examples

Covid-19 Vaccination
Example immunization

{
    "resourceType": "Immunization",
    "id": "immunization-covid19",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/immunization"
        ]
    },
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "code": "1119349007",
                "system": "http://snomed.info/sct",
                "display": "Vaccine product containing only Severe acute respiratory syndrome coronavirus 2 messenger ribonucleic acid (medicinal product)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/gecco-patient"
    },
    "occurrenceDateTime": "2020-12-27",
    "protocolApplied":  [
        {
            "targetDisease":  [
                {
                    "coding":  [
                        {
                            "code": "840539006",
                            "system": "http://snomed.info/sct",
                            "display": "Disease caused by Severe acute respiratory syndrome coronavirus 2 (disorder)"
                        }
                    ]
                }
            ],
            "_doseNumberString": {
                "extension":  [
                    {
                        "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                        "valueCode": "unknown"
                    }
                ]
            }
        }
    ]
}


Pneumococcal Immunization
Example immunization

{
    "resourceType": "Immunization",
    "id": "immunization-pneumococcal-disease",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/immunization"
        ]
    },
    "status": "completed",
    "vaccineCode": {
        "coding":  [
            {
                "code": "836398006",
                "system": "http://snomed.info/sct",
                "display": "Vaccine product containing Streptococcus pneumoniae antigen (medicinal product)"
            }
        ]
    },
    "patient": {
        "reference": "Patient/gecco-patient"
    },
    "occurrenceDateTime": "2020-10-06",
    "protocolApplied":  [
        {
            "targetDisease":  [
                {
                    "coding":  [
                        {
                            "code": "16814004",
                            "system": "http://snomed.info/sct",
                            "display": "Pneumococcal infectious disease (disorder)"
                        }
                    ]
                }
            ],
            "_doseNumberString": {
                "extension":  [
                    {
                        "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                        "valueCode": "unknown"
                    }
                ]
            }
        }
    ]
}


No known Immunizations
Example immunization

{
    "resourceType": "Immunization",
    "id": "immunization-none-known",
    "meta": {
        "profile":  [
            "https://www.netzwerk-universitaetsmedizin.de/fhir/StructureDefinition/immunization"
        ]
    },
    "status": "not-done",
    "vaccineCode": {
        "coding":  [
            {
                "code": "no-known-immunizations",
                "system": "http://hl7.org/fhir/uv/ips/CodeSystem/absent-unknown-uv-ips",
                "display": "No known immunizations"
            }
        ]
    },
    "patient": {
        "reference": "Patient/gecco-patient"
    },
    "_occurrenceDateTime": {
        "extension":  [
            {
                "url": "http://hl7.org/fhir/StructureDefinition/data-absent-reason",
                "valueCode": "unknown"
            }
        ]
    }
}