{

"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,
"reportOrigin": {
  "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"
    }
  ]
}

}