Patient reports they previous said they took Amoxicillin but really didn't (id = "example005")

<?xml version="1.0" encoding="UTF-8"?>

<!--   This example is a fully populated example where a patient reports they said they
 took this but really did not    --><MedicationStatement xmlns="http://hl7.org/fhir">
  <id value="example005"/> 
  <status value="entered-in-error"/> 
  <medication> 
    <concept> 
      <coding> 
        <system value="http://snomed.info/sct"/> 
        <code value="27658006"/> 
        <display value="Product containing amoxicillin (medicinal product)"/> 
      </coding> 
    </concept> 
  </medication> 
  <subject> 
    <reference value="Patient/pat1"/> 
    <display value="Donald Duck"/> 
  </subject> 
  <encounter> 
    <reference value="Encounter/f203"/> 
  </encounter> 
  <effectiveDateTime value="2014-01-23"/> 
  <dateAsserted value="2015-02-22"/> 
  <informationSource> 
    <reference value="Patient/pat1"/> 
    <display value="Donald Duck"/> 
  </informationSource> 
  <note> 
    <text value="Patient indicated that they thought it was Amoxicillin they were taking but it
     was really Erythromycin"/> 
  </note> 
</MedicationStatement>