This page is part of the Common Data Models Harmonization FHIR IG (v1.0.0: STU 1) based on FHIR R4. This is the current published version. For a full list of available versions, see the Directory of published versions
<AdverseEvent xmlns="http://hl7.org/fhir">
<id value="example"/>
<meta>
<extension url="http://hl7.org/fhir/StructureDefinition/instance-name">
<valueString value="AdverseEvent Example"/>
</extension>
<extension
url="http://hl7.org/fhir/StructureDefinition/instance-description">
<valueMarkdown
value="This is an example for the *CDMH AdverseEvent Profile*."/>
</extension>
<profile
value="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-adverseevent"/>
</meta>
<text>
<status value="extensions"/>
<div xmlns="http://www.w3.org/1999/xhtml"><p><b>Adverse Event Example</b></p></div>
</text>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-source" id="1">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-match-confidence" id="2">
<valueCode value="F"/>
</extension>
<identifier>
<system value="http://acme.com/ids/patients/risks"/>
<value value="49476534"/>
</identifier>
<actuality value="actual"/>
<category>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adverse-event-category"/>
<code value="medication-mishap"/>
<display value="Medication Mishap"/>
</coding>
</category>
<event>
<coding>
<system value="http://snomed.info/sct"/>
<code value="304386008"/>
<display value="O/E - itchy rash"/>
</coding>
<text value="This was a mild rash on the left forearm"/>
</event>
<subject>
<reference value="Patient/example"/>
</subject>
<date value="2017-01-29T12:34:56+00:00"/>
<seriousness>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adverse-event-seriousness"/>
<code value="non-serious"/>
<display value="Non-serious"/>
</coding>
</seriousness>
<severity>
<coding>
<system
value="http://terminology.hl7.org/CodeSystem/adverse-event-severity"/>
<code value="mild"/>
<display value="Mild"/>
</coding>
</severity>
<suspectEntity>
<instance>
<reference value="Medication/example"/>
</instance>
<causality id="1234">
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause">
<valueString value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-code">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-confidence" id="3">
<valueCode value="F"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-type" id="4">
<valueCode value="C"/>
</extension>
<extension
url="http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-source" id="5">
<valueCode value="F"/>
</extension>
</causality>
</suspectEntity>
</AdverseEvent>