<Immunization xmlns="http://hl7.org/fhir"><id value="historical"/><identifier><system value="urn:ietf:rfc:3986"/><value value="urn:oid:1.3.6.1.4.1.21367.2005.3.7.1234"/></identifier><status value="completed"/><vaccineCode><coding><system value="urn:oid:1.2.36.1.2001.1005.17"/><code value="GNFLU"/></coding><text value="Influenza"/></vaccineCode><patient><reference value="Patient/example"/></patient><occurrenceString value="January 2012"/><primarySource value="false"/><informationSource><concept><coding><system value="http://terminology.hl7.org/CodeSystem/immunization-origin"/><code value="record"/></coding><text value="Written Record"/></concept></informationSource><location><reference value="Location/1"/></location><note><text value="Notes on adminstration of a historical vaccine"/></note></Immunization>