Influenza Vaccination - Patient Reported

back to homepage

Approval Status

  • Approval Status: Approved
  • Example Task Force: 7/28/2022
  • SDWG: 3/9/2023

C-CDA 2.1 Example:

  • 2.16.840.1.113883.
  • 2.16.840.1.113883.
  • Immunization Activity 2.16.840.1.113883.
  • 2.16.840.1.113883.

Reference to full CDA sample:

  • Immunizations in empty CCD

Validation location


  • This example illustrates how to structure Immunizations when it's reported by a patient


  • Brett Marquard, (GitHub: brettmarquard)


  • substance, immunzation


Example: download example view on GitHub

        <!-- Immunizations section with entries required -->
        <templateId root="2.16.840.1.113883."/>
        <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
        <code code="11369-6" codeSystem="2.16.840.1.113883.6.1" codeSystemName="LOINC"
            displayName="History of immunizations"/>
            <content ID="immunSect"/>
            <table border="1" width="100%">
                        <th>Lot Number</th>
                    <tr ID="immun1">
                        <td ID="ImmunizationProduct_100">Influenza Virus Vaccine</td>
                        <td>Patient Reported</td>
        <entry typeCode="DRIV">
            <substanceAdministration classCode="SBADM" moodCode="EVN" negationInd="false">
                <!-- ** Immunization activity ** -->
                <templateId root="2.16.840.1.113883."/>
                <templateId root="2.16.840.1.113883." extension="2015-08-01"/>
                <id root="3b3e2533-46aa-4e3f-b675-12ac6749cdcd"/>
                    <reference value="#immun1"/>
                <!-- Indicates the status of the substanceAdministartion -->
                <statusCode code="completed"/>
                <effectiveTime value="20100815"/>
                    <manufacturedProduct classCode="MANU">
                        <!-- ** Immunization medication information ** -->
                        <templateId root="2.16.840.1.113883."/>
                        <templateId root="2.16.840.1.113883." extension="2014-06-09"/>
                            <code code="88" codeSystem="2.16.840.1.113883.12.292"
                                displayName="influenza virus vaccine, unspecified formulation" codeSystemName="CVX">
                                    <reference value="#ImmunizationProduct_100"/>
                    <!-- Optional manufacturerOrganization
                        <name>Health LS - Immuno Inc.</name>
              <!-- Optional Author -->
                    <templateId root="2.16.840.1.113883."/>
                    <!-- Provenance - Author Participation -->
                    <templateId root="2.16.840.1.113883." extension="2019-10-01"/>
                    <time value="20100815"/>
                        <!-- NPI of Author (example) -->
                        <id root="2.16.840.1.113883.4.6" extension="9911223334"/>
                        <code code="207Q00000X" codeSystem="2.16.840.1.113883.6.101" codeSystemName="Health Care Provider Taxonomy" displayName="Allopathic &amp; Osteopathic Physicians; Family Medicine" />
                        <telecom use="WP" value="tel:555-555-1002"/>
                            <id root="2.16.840.1.113883.19.5.9999.1394"/>
                            <name>Good Health Clinic</name>
                            <telecom nullFlavor="UNK"/>
                            <addr nullFlavor="UNK"/>
                        <!-- This is a fictional OID and identifier for the patient. This should be adapted to local implementation -->
                        <id root="2.16.840.1.113883.3.3208.101.2" extension="20130607100800-Patient2"/>
                        <addr use="HP">
                            <streetAddressLine>1111 StreetName St.</streetAddressLine>
                            <city>Silver Spring</city>
                        <telecom value="tel:+1(301)111-1111" use="HP"/>
  1. C-CDA Example Search Help

    C-CDA Example Search Results
    This screen displays the results of executing the example search criteria against the existing examples recorded in the example database.

  2. Search Criteria Panel

    This panel allow you to further refine your queries and narrow the results

  3. Text Search Words

    Use this field to enter words related to your search. These words can appear in the title, the comments or as part of a special list of keywords associated with the example. The search words should be entered with spaces separating the items.

  4. Filter by example status

    By selecting the various statuses, the search results can be limited to only the example that are set to the selected status(es). By removing all status selections, the filtering is removed and examples from all statuses will be returned (based on any other filtering).

  5. Select only ONC Certified examples

    These are samples referenced in a government rule or certification companion guide.

  6. Execute the search based on the criteria entered (or retrieve all examples if no criteria specified).

  7. The number of results that match the query parameters can be found here.

  8. Use this link to jump back to the initial page of the application (that lists the sections).

  9. This columns list the names of the examples that match the criteria (and the comment for each example).

  10. This columns lists the area in the C-CDA specification (the specification is broken into distinct topics for the various exchangeable documents, the common header, and the sections that occur within the exchangeable documents) that the example demonstrates.

  11. This columns lists the state of the example in the example verification and approval process.

  12. You can select to download the examples directly or navigate to page with the full detailed description of the example.

  13. Tour Complete

    Return to the C-CDA Example Search Results page.