Sample HL7 Immunization Messages

This is a collection of sample HL7 Immunization Messages that you can cut and paste for testing purposes:

ORU R01: VAERS Message (Medium)

MSH|^~\&||GA0000||VAERS PROCESSOR|20010331605||ORU^RO1|20010422GA03|T|2.3.1|||AL|
PID|||1234^^^^SR~1234-12^^^^LR~00725^^^^MR||Doe^John^Fitzgerald^JR^^^L||20001007|M||2106-3^White^HL70005|123 Peachtree St^APT 3B^Atlanta^GA^30210^^M^^GA067||(678) 555-1212^^PRN|
NK1|1|Jones^Jane^Lee^^RN|VAB^Vaccine administered by (Name)^HL70063|
NK1|2|Jones^Jane^Lee^^RN|FVP^Form completed by (Name)-Vaccine provider^HL70063|101 Main Street^^Atlanta^GA^38765^^O^^GA121||(404) 554-9097^^WPN|
ORC|CN|||||||||||1234567^Welby^Marcus^J^Jr^Dr.^MD^L|||||||||Peachtree Clinic|101 Main Street^^Atlanta^GA^38765^^O^^GA121|(404) 554-9097^^WPN|101 Main Street^^Atlanta^GA^38765^^O^^GA121|
OBR|1|||^CDC VAERS-1 (FDA) Report|||20010316|
OBX|1|NM|21612-7^Reported Patient Age^LN||05|mo^month^ANSI|
OBX|1|TS|30947-6^Date form completed^LN||20010316|
OBX|2|FT|30948-4^Vaccination adverse events and treatment, if any^LN|1|fever of 106F, with vomiting, seizures, persistent crying lasting over 3 hours, loss of appetite|
OBX|3|CE|30949-2^Vaccination adverse event outcome^LN|1|E^required emergency room/doctor visit^NIP005|
OBX|4|CE|30949-2^Vaccination adverse event outcome^LN|1|H^required hospitalization^NIP005|
OBX|5|NM|30950-0^Number of days hospitalized due to vaccination adverse event^LN|1|02|d^day^ANSI|
OBX|6|CE|30951-8^Patient recovered^LN||Y^Yes^ HL70239|
OBX|7|TS|30952-6^Date of vaccination^LN||20010216|
OBX|8|TS|30953-4^Adverse event onset date and time^LN||200102180900|
OBX|9|FT|30954-2^Relevant diagnostic tests/lab data^LN||Electrolytes, CBC, Blood culture|
OBR|2|||30955-9^All vaccines given on date listed in #10^LN|
OBX|1|CE30955-9&30956-7^Vaccine type^LN|1|08^HepB-Adolescent/pediatric^CVX|
OBX|2|CE|30955-9&30957-5^Manufacturer^LN|1|MSD^Merck^MVX|
OBX|3|ST|30955-9&30959-1^Lot number^LN|1|MRK12345|
OBX|4|CE|30955-9&30958-3^ Route^LN|1|IM^Intramuscular ^HL70162|
OBX|5|CE|30955-9&31034-2^Site^LN|1|LA^Left arm^ HL70163|
OBX|6|NM|30955-9&30960-9^Number of previous doses^LN|1|01I
OBX|7|CE|CE|30955-9&30956-7^Vaccine type^LN|2|50^DTaP-Hib^CVX|
OBX|8|CE|30955-9&30957-5^ Manufacturer^LN|2|WAL^Wyeth_Ayerst^MVX|
OBX|9|ST|30955-9&30959-1^Lot number^LN|2|W46932777|
OBX|10|CE|30955-9&30958-3^ Route^LN|2|IM^Intramuscular^HL70162|

ORU R01: VAERS Message (Long)

MSH|^~\&||GA0000||VAERS PROCESSOR|20010331605||ORU^R01|20010422GA03|T|2.3.1|||AL|
PID|||1234^^^^SR~1234-12^^^^LR~00725^^^^MR||Doe^John^Fitzgerald^JR^^^L||20001007|M||2106-3^White^HL70005|123 Peachtree St^APT 3B^Atlanta^GA^30210^^M^^GA067||(678) 555-1212^^PRN|
NK1|1|Jones^Jane^Lee^^RN|VAB^Vaccine administered by (Name)^HL70063|
NK1|2|Jones^Jane^Lee^^RN|FVP^Form completed by (Name)-Vaccine provider^HL70063|101 Main Street^^Atlanta^GA^38765^^O^^GA121||(404) 554-9097^^WPN|
ORC|CN|||||||||||1234567^Welby^Marcus^J^Jr^Dr.^MD^L|||||||||Peachtree Clinic|101 Main Street^^Atlanta^GA^38765^^O^^GA121|(404) 554-9097^^WPN|101 Main Street^^Atlanta^GA^38765^^O^^GA121|
OBR|1|||^CDC VAERS-1 (FDA) Report|||20010316|
OBX|1|NM|21612-7^Reported Patient Age^LN||05|mo^month^ANSI|
OBX|1|TS|30947-6^Date form completed^LN||20010316|
OBX|2|FT|30948-4^Vaccination adverse events and treatment, if any^LN|1|fever of 106F, with vomiting, seizures, persistent crying lasting over 3 hours, loss of appetite|
OBX|3|CE|30949-2^Vaccination adverse event outcome^LN|1|E^required emergency room/doctor visit^NIP005|
OBX|4|CE|30949-2^Vaccination adverse event outcome^LN|1|H^required hospitalization^NIP005|
OBX|5|NM|30950-0^Number of days hospitalized due to vaccination adverse event^LN|1|02|d^day^ANSI|
OBX|6|CE|30951-8^Patient recovered^LN||Y^Yes^ HL70239|
OBX|7|TS|30952-6^Date of vaccination^LN||20010216|
OBX|8|TS|30953-4^Adverse event onset date and time^LN||200102180900|
OBX|9|FT|30954-2^Relevant diagnostic tests/lab data^LN||Electrolytes, CBC, Blood culture|
OBR|2|||30955-9^All vaccines given on date listed in #10^LN|
OBX|1|CE30955-9&30956-7^Vaccine type^LN|1|08^HepB-Adolescent/pediatric^CVX|
OBX|2|CE|30955-9&30957-5^Manufacturer^LN|1|MSD^Merck^MVX|
OBX|3|ST|30955-9&30959-1^Lot number^LN|1|MRK12345|
OBX|4|CE|30955-9&30958-3^ Route^LN|1|IM^Intramuscular ^HL70162|
OBX|5|CE|30955-9&31034-2^Site^LN|1|LA^Left arm^ HL70163|
OBX|6|NM|30955-9&30960-9^Number of previous doses^LN|1|01I
OBX|7|CE|CE|30955-9&30956-7^Vaccine type^LN|2|50^DTaP-Hib^CVX|
OBX|8|CE|30955-9&30957-5^ Manufacturer^LN|2|WAL^Wyeth_Ayerst^MVX|
OBX|9|ST|30955-9&30959-1^Lot number^LN|2|W46932777|
OBX|10|CE|30955-9&30958-3^ Route^LN|2|IM^Intramuscular^HL70162|
OBX|11|CE|30955-9&31034-2^Site^LN|2|LA^Left arm^HL70163|
OBX|12|NM|30955-9&30960-9^Number of previous doses^LN|2|01|
OBR|3|||30961-7^Any other vaccinations within 4 weeks prior to the date listed in #10|
OBX|1|CE|30961-7&30956-7^Vaccine type^LN|1|10^IPV^CVX|
OBX|2|CE|30961-7&30957-5^Manufacturer^LN|1|PMC^Aventis Pasteur ^MVX|
OBX|3|ST|30961-7&30959-1^Lot number^LN|1|PMC123456|
OBX|4|CE|30961-7&30958-3^Route^LN|1|SC^Subcutaneaous^HL70162|
OBX|5|CE|30961-7&31034-2^Site^LN|1|LA^Left arm^HL70163|
OBX|6|NM|30961-7&30960-9^Number of previous doses^LN|1|01|
OBX|7|TS|30961-7&31035-9^date given^LN|1|20001216|
OBX|8|CE|30962-^Vaccinated at^LN||PVT^Private doctor’s office/hospital^NIP009|
OBX|9|CE|30963-3^Vaccine purchased with^LN||PBF^Public funds^NIP008|
OBX|10|FT|30964-1^Other medications^LN||None|
OBX|11|FT|30965-8^Illness at time of vaccination (specify)^LN||None|
OBX|12|FT|30966-6^Pre-existing physician diagnosed allergies, birth defects, medical conditions^LN||Past conditions convulsions|
OBX|13|CE|30967-4^Was adverse event reported previously^LN||N^no^NIP009|
OBR|4||30968-2^Adverse event following prior vaccination in patient^LN|
OBX|1|TX|30968-2&30971-6^Adverse event^LN||None|
OBR|5||30969-0^Adverse event following prior vaccination in brother^LN|
OBX|1|TX||30969-0&30971-6^Adverse event^LN||vomiting, fever, otitis media|
OBX|2|NM||30969-0&30972-4^Onset age^LN||04|mo^month^ANSI|
OBX|3|CE||30969-0&30956-7^Vaccine Type ^LN||10^IPV^CVX|
OBX|4|NM||30969-0&30973-2^Dose number in series^LN||02|
OBR|6|||30970-8^Adverse event following prior vaccination in sister^LN|
OBX|1|TX|30970-8&30971-6^Adverse event^LN||None|
OBR|7||^For children 5 and under|
OBX|1|NM|8339-4^Body weight at birth^LN||82|oz^ounces^ANSI|
OBX|2|NM|30974-0^Number of brothers and sisters^LN||2|
OBR|8|||^Only for reports submitted by manufacturer/immunization project|
OBX|1|ST|30975-7^Mfr./Imm. Proj. report no.^LN||12345678|
OBX|2|TS|30976-5^Date received by manufacturer/immunization project^LN||12345678|
OBX|3|CE|30977-3^15 day report^LN||N^No^HL70136|
OBX|4|CE|30978-1^Report type^LN||IN^Initial^NIP010|

VXQ V01: Vaccine Query

VXX V02: Vaccine Query Response (Multiple Matches)

VXR V03: Vaccine Query Reponse (Single Match)

MSH|^~\&||MA0000||GA0000|199705221610||VXR^V03|19970522MA53|T|2.3.1|||AL
MSA|AA|19970522GA40|
QRD|199705221605|R|I|19970522GA05|||25^RD|^KENNEDY^JOHN^FITZGERALD^JR|VXI|^SIIS
QRF|MA0000||||256946789~19900607~MA~MA99999999~88888888~KENNEDY^JACQUELINE^LEE~BOUVIER~898666725~KENNEDY^JOHN^FITZGERALD~822546618
PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^~430078856^^^^MA^ ||KENNEDY^JOHN^FITZGERALD^JR^^^L|BOUVIER^^^^^^M|19900607|M|KENNEDY^BABY BOY^^^^^^ B|W^WHITE^NY8 RACE CODES^W^WHITE^HL70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSA CODE^MA034~345 ELM ST^^BOSTON^MA^00314^^BLD~^^^^^^BR^^MA002| |(617) 555-1212 ^PRN^PH^^^617^5551212^^||EN^ENGLISH^HL70296^^^|||||||WN^NOT HISPANIC^LOCAL CODE SET^NH^NOT OF HISPANIC ORIGIN^HL70189|CHILDREN=S HOSPITAL
PD1|||CHILDREN=S HOSPITAL^L^1234^^^^XX~LEXINGTON CLINIC^^1234A^^^^FI |12345^CARE^ PRIMARY^^^DR^MD^^^L^^^DN|||||||03^REMINDER/RECALL - NO CALLS^HL70215|Y|A|19900607
NK1|1|KENNEDY^JACQUELINE^LEE|32^MOTHER^HL70063||||||||||||||||||||||||||||||898666725^^^^SS
NK1|2|KENNEDY^JOHN^FITZGERALD|33^FATHER^HL70063||||||||||||||||||||||||||||||822546618^^^^SS
PV1||R||||||||||||||||||V02^19900607~H02^19900607
RXA|0|1|19900607|19900607|08^HEPB-PEDIATRIC/ADOLESCENT^CVX^90744^HEPB-PEDATRIC /ADOLESCENT^CPT|.5|ML^^ISO+||03^HISTORICAL INFORMATION - FROM PARENT=S WRITTEN RECORD^NIP0001|^JONES^LISA|^^^CHILDREN=S HOSPITAL||5|MCG^^ISO+|MRK12345|199206|MSD ^MERCK^MVX
RXA|0|0|19901207|19901207|20^DTAP^CVX|.5|ML^^ISO+|||1234567891^O=BRIAN^ROBERT^A^^DR^ MD|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W22532806| 19901230| PMC^ PASTEUR MERIEUX CONNAUGHT^MVX|00^PARENTAL DECISION^NIP002||RE
RXA|0|1|19910907|19910907|50^DTAP-HIB^CVX^90721^DTAP-HIB^CPT|.5|ML^^ISO+||00^NEW IMMUNIZATION RECORD^NIP001|1234567890^SMITH^SALLY^S^^^^^^^^^VEI~ 1234567891^O=BRIAN^ROBERT^A^^DR^MD^^^^^^OEI|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA ||||W46932777| 199208|PMC^PASTEUR MERIEUX CONNAUGHT^MVX|||CP|A| 19910907120030
RXR|IM^INTRAMUSCULAR^HL70162|LA^LEFT ARM^HL70163
OBX|1|NM|60000-7^DTAP DOSE COUNT IN COMBINATION VACCINE^LN||4||||||F
OBX|2|NM|60002-3^HIB DOSE COUNT IN COMBINATION VACCINE^LN||4||||||F
RXA|0|1|19910907|19910907|03^MMR^CVX|.5|ML^^ISO+|||1234567890^SMITH^SALLY^S^^^^^^^^^VEI~1234567891^O=BRIAN^ROBERT^A^^DR^MD^^^^^^OEI|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W2348796456|19920731|MSD^MERCK^MVX
RXR|SC^SUBCUTANEOUS^HL70162|LA^LEFT ARM^HL70163
RXA|0|5|19950520|19950520|20^DTAP^CVX|.5|ML^^ISO+|||1234567891^O=BRIAN^ROBERT^A^^DR^MD|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W22532806|19950705| PMC^PASTEUR MERIEUX CONNAUGHT^MVX
RXR|IM^INTRAMUSCULAR^HL70162|LA^LEFT ARM^HL70163
RXA|0|2|19950520|19950520|03^MMR^CVX|.5|ML^^ISO+|||1234567891^O=BRIAN^ROBERT^A^^DR^MD|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W2341234567|19950630| MSD^ MERCK^MVX
RXR|SC^SUBCUTANEOUS^HL70162|LA^LEFT ARM^HL70163
OBX||ST|60011-4^VACCINATION ADVERSE EVENT^LN||ANAPHYLAXIS||||||F
NTE|||VAERS FORM SUBMITTED BY PROVIDER
RXA|0|1|19960415|19960415|96^TST-PPD INTRADERMAL^CVX|5|TU
OBX||NM|1648-5^TUBERCULOSIS REACTION WHEAL 3D POST 5 TU ID^LN||1|MM||N|||F|||19960418

VXU V04: Unsolicited Vaccine Update (Short)

VXU V04: Unsolicited Vaccine Update (Long)

MSH|^~\&||MA0000||GA0000|19970901||VXU^V04|19970522MA53|T|2.3.1|||AL
PID|||1234^^^^SR^~1234-12^^^^LR^~3872^^^^MR~221345671^^^^SS^~430078856^^^^MA^ ||KENNEDY^JOHN^FITZGERALD^JR^^^L|BOUVIER^^^^^^M|19900607|M|KENNEDY^BABY BOY^^^^^^ B|W^WHITE^NY8 RACE CODES^W^WHITE^HL70005|123 MAIN ST^APT 3B^LEXINGTON^MA^00210^ ^M^MSA CODE^MA034~345 ELM ST^^BOSTON^MA^00314^^BLD~^^^^^^BR^^MA002| |(617) 555-1212 ^PRN^PH^^^617^5551212^^||EN^ENGLISH^HL70296^^^|||||||WN^NOT HISPANIC^LOCAL CODE SET^NH^NOT OF HISPANIC ORIGIN^HL70189|CHILDREN=S HOSPITAL
PD1|||CHILDREN=S HOSPITAL^^1234^^^^XX~LEXINGTON CLINIC^^1234A^^^^FI|12345^CARE^ PRIMARY^^^DR^MD^^^L^^^DN|||||||03^REMINDER/RECALL - NO CALLS^HL70215|Y
NK1|1|KENNEDY^JACQUELINE^LEE|32^MOTHER^HL70063||||||||||||||||||||||||||||||898666725^^^^SS
NK1|2|KENNEDY^JOHN^FITZGERALD|33^FATHER^HL70063||||||||||||||||||||||||||||||822546618^^^^SS
PV1||R|||||||||||||||A|||V02^19900607~H02^19900607
RXA|0|1|19900607|19900607|08^HEPB-PEDIATRIC/ADOLESCENT^CVX^90744^HEPB-PEDATRIC/ADOLESCENT^CPT|.5|ML^^ISO+||03^HISTORICAL INFORMATION - FROM PARENT=S WRITTEN RECORD^NIP0001|^JONES^LISA|^^^CHILDREN=S HOSPITAL||5|MCG^^ISO+|MRK12345| 199206|MSD^MERCK^MVX
RXA|0|4|19910907|19910907|50^DTAP-HIB^CVX^90721^DTAP-HIB^CPT|.5|ML^^ISO+||00^NEW IMMUNIZATION RECORD^NIP0001|1234567890^SMITH^SALLY^S^^^^^^^^^VEI~1234567891 ^O=BRIAN^ROBERT^A^^DR^MD^^^^^^OEI|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^ BOSTON^MA||||W46932777|199208|PMC^PASTEUR MERIEUX CONNAUGHT^MVX|||CP|A| 19910907120030
RXR|IM^INTRAMUSCULAR^HL70162|LA^LEFT ARM^HL70163
RXA|0|1|19910907|19910907|03^MMR^CVX|.5|ML^^ISO+|||1234567890^SMITH^SALLY^S^^^^^^^^^VEI~1234567891^O=BRIAN^ROBERT^A^^DR^MD^^^^^^OEI|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W2348796456|19920731|MSD^MERCK^MVX
RXR|SC^SUBCUTANEOUS^HL70162|LA^LEFT ARM^HL70163
RXA|0|5|19950520|19950520|20^DTAP^CVX|.5|ML^^ISO+|||1234567891^O=BRIAN^ROBERT^A^^DR|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W22532806|19950705|PMC^ PASTEUR MERIEUX CONNAUGHT^MVX
RXR|IM^INTRAMUSCULAR^HL70162|LA^LEFT ARM^HL70163
NTE|PATIENT DEVELOPED HIGH FEVER APPROX 3 HRS AFTER VACCINE INJECTION
RXA|0|2|19950520|19950520|03^MMR^CVX|.5|ML^^ISO+|||1234567891^O=BRIAN^ROBERT^A^^DR|^^^CHILD HEALTHCARE CLINIC^^^^^101 MAIN STREET^^BOSTON^MA||||W2341234567|19950630| MSD^MERCK^MVX
RXR|SC^SUBCUTANEOUS^HL70162|LA^LEFT ARM^HL70163

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