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Source1

{
  "resourceType": "AdverseEvent",
  "id": "example",
  "meta": {
    "extension": [
      {
        "url": "http://hl7.org/fhir/StructureDefinition/instance-name",
        "valueString": "AdverseEvent Example"
      },
      {
        "url": "http://hl7.org/fhir/StructureDefinition/instance-description",
        "valueMarkdown": "This is an example for the *CDMH AdverseEvent Profile*."
      }
    ],
    "profile": [
      "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-adverseevent"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "extension": [
    {
      "id": "1",
      "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-source",
      "valueCode": "F"
    },
    {
      "id": "2",
      "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-match-confidence",
      "valueCode": "F"
    }
  ],
  "identifier": {
    "system": "http://acme.com/ids/patients/risks",
    "value": "49476534"
  },
  "actuality": "actual",
  "category": [
    {
      "coding": [
        {
          "system": "http://terminology.hl7.org/CodeSystem/adverse-event-category",
          "code": "medication-mishap",
          "display": "Medication Mishap"
        }
      ]
    }
  ],
  "event": {
    "coding": [
      {
        "system": "http://snomed.info/sct",
        "code": "304386008",
        "display": "O/E - itchy rash"
      }
    ],
    "text": "This was a mild rash on the left forearm"
  },
  "subject": {
    "reference": "Patient/example"
  },
  "date": "2017-01-29T12:34:56+00:00",
  "seriousness": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/adverse-event-seriousness",
        "code": "non-serious",
        "display": "Non-serious"
      }
    ]
  },
  "severity": {
    "coding": [
      {
        "system": "http://terminology.hl7.org/CodeSystem/adverse-event-severity",
        "code": "mild",
        "display": "Mild"
      }
    ]
  },
  "suspectEntity": [
    {
      "instance": {
        "reference": "Medication/example"
      },
      "causality": [
        {
          "id": "1234",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause",
              "valueString": "F"
            },
            {
              "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-code",
              "valueCode": "F"
            },
            {
              "id": "3",
              "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-confidence",
              "valueCode": "F"
            },
            {
              "id": "4",
              "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-type",
              "valueCode": "C"
            },
            {
              "id": "5",
              "url": "http://hl7.org/fhir/us/cdmh/StructureDefinition/cdmh-pcornet-death-cause-source",
              "valueCode": "F"
            }
          ]
        }
      ]
    }
  ]
}