{
  "resourceType": "Immunization",
  "id": "historical",
  "identifier": [
    {
      "system": "urn:ietf:rfc:3986",
      "value": "urn:oid:1.3.6.1.4.1.21367.2005.3.7.1234"
    }
  ],
  "status": "completed",
  "vaccineCode": {
    "coding": [
      {
        "system": "urn:oid:1.2.36.1.2001.1005.17",
        "code": "GNFLU"
      }
    ],
    "text": "Influenza"
  },
  "patient": {
    "reference": "Patient/example"
  },
  "occurrenceString": "January 2012",
  "primarySource": false,
  "informationSource": {
    "concept": {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/immunization-origin",
          "code": "record"
        }
      ],
      "text": "Written Record"
    }
  },
  "location": {
    "reference": "Location/1"
  },
  "note": [
    {
      "text": "Notes on adminstration of a historical vaccine"
    }
  ],
  "meta": {
    "tag": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/v3-ActReason",
        "code": "HTEST",
        "display": "test health data"
      }
    ]
  }
}