FHIR IG Statistics: Questionnaire/QIMMZD17

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Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Questionnaire QIMMZD17

Language: en

Profile: Extractable Questionnaire - StructureMap

LinkID	Text	Cardinality	Type	Description & Constraints
	Questionnaire for IMMZ.D17.Report AEFI		Questionnaire	http://smart.who.int/immunizations/Questionnaire/QIMMZD17#0.2.0
reactionReported	Reaction reported	0..1	boolean
reactionDate	Reaction date	1..1	date	Enable When: reactionReported =
reactionManifestation	Reaction manifestation	1..1	choice	Enable When: reactionReported = Value Set: IMMZ.D.DE95 ValueSet for Reaction manifestation
typeOfReaction	Type of reaction	1..1	choice	Enable When: reactionReported = Value Set: IMMZ.D.DE107 ValueSet for Type of reaction
otherImportantMedicalEvent	Other important medical event (specify)	0..1	string
reactionOutcome	Reaction outcome	1..1	choice	Enable When: reactionReported = Value Set: IMMZ.D.DE115 ValueSet for Reaction outcome
Documentation for this format

Contained Resources

---

ValueSet #IMMZ.D.DE95

This value set expansion contains 9 concepts.

Code	System	Display	Definition
DE96	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Severe local reaction	The client's reaction manifested in severe local reaction
DE98	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Seizures	The client's reaction manifested in seizures
DE99	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Abscess	The client's reaction manifested in an abscess
DE100	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Sepsis	The client's reaction manifested in sepsis
DE101	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Encephalopathy	The client's reaction manifested in encephalopathy
DE102	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Toxic shock syndrome	The client's reaction manifested in toxic shock syndrome
DE103	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Anaphylaxis	The client's reaction manifested in anaphylaxis
DE104	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Fever	The client's reaction manifested as a fever
DE105	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Other	The client's reaction manifested in another way

---

ValueSet #IMMZ.D.DE107

This value set expansion contains 6 concepts.

Code	System	Display	Definition
DE174	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Non serious	The reaction resulted in a mild or minor response and did not pose a significant threat to client's health
DE108	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Death	The reaction resulted in the client's death
DE109	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Life threatening	The reaction threatened the client's life
DE110	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Disability	The reaction resulted in a disability
DE111	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Hospitalization	The reaction resulted in a hospitalization
DE112	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Congenital anomaly	The reaction was a congenital anomaly or birth defect

---

ValueSet #IMMZ.D.DE115

This value set expansion contains 6 concepts.

Code	System	Display	Definition
DE116	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Died	The adverse event resulted in the client's death
DE117	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Recovered	The client fully recovered
DE118	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Recovered with sequelae	The client has recovered with sequelae as a consequence of the reaction/vaccination
DE119	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Recovering	The client is recovering
DE120	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Not recovered	The client has not recovered
DE121	http://smart.who.int/immunizations/CodeSystem/IMMZ.D	Unknown	The client's reaction outcome is unknown

Source

{
  "resourceType": "Questionnaire",
  "id": "QIMMZD17",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-extr-smap"
    ]
  },
  "language": "en",
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "ValueSet",
      "id": "IMMZ.D.DE95",
      "url": "http://smart.who.int/immunizations/ValueSet/IMMZ.D.DE95",
      "name": "IMMZ_D_DE95",
      "title": "IMMZ.D.DE95 ValueSet for Reaction manifestation",
      "status": "active",
      "description": "ValueSet for Reaction manifestation for IMMZ.D.DE95",
      "compose": {
        "include": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "concept": [
              {
                "code": "DE96",
                "display": "Severe local reaction"
              },
              {
                "code": "DE98",
                "display": "Seizures"
              },
              {
                "code": "DE99",
                "display": "Abscess"
              },
              {
                "code": "DE100",
                "display": "Sepsis"
              },
              {
                "code": "DE101",
                "display": "Encephalopathy"
              },
              {
                "code": "DE102",
                "display": "Toxic shock syndrome"
              },
              {
                "code": "DE103",
                "display": "Anaphylaxis"
              },
              {
                "code": "DE104",
                "display": "Fever"
              },
              {
                "code": "DE105",
                "display": "Other"
              }
            ]
          }
        ]
      },
      "expansion": {
        "timestamp": "2025-06-25T16:39:07.092Z",
        "contains": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE96",
            "display": "Severe local reaction"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE98",
            "display": "Seizures"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE99",
            "display": "Abscess"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE100",
            "display": "Sepsis"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE101",
            "display": "Encephalopathy"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE102",
            "display": "Toxic shock syndrome"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE103",
            "display": "Anaphylaxis"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE104",
            "display": "Fever"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE105",
            "display": "Other"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "IMMZ.D.DE107",
      "url": "http://smart.who.int/immunizations/ValueSet/IMMZ.D.DE107",
      "name": "IMMZ_D_DE107",
      "title": "IMMZ.D.DE107 ValueSet for Type of reaction",
      "status": "active",
      "description": "ValueSet for Type of reaction for IMMZ.D.DE107",
      "compose": {
        "include": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "concept": [
              {
                "code": "DE174",
                "display": "Non serious"
              },
              {
                "code": "DE108",
                "display": "Death"
              },
              {
                "code": "DE109",
                "display": "Life threatening"
              },
              {
                "code": "DE110",
                "display": "Disability"
              },
              {
                "code": "DE111",
                "display": "Hospitalization"
              },
              {
                "code": "DE112",
                "display": "Congenital anomaly"
              }
            ]
          }
        ]
      },
      "expansion": {
        "timestamp": "2025-06-25T16:39:07.092Z",
        "contains": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE174",
            "display": "Non serious"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE108",
            "display": "Death"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE109",
            "display": "Life threatening"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE110",
            "display": "Disability"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE111",
            "display": "Hospitalization"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE112",
            "display": "Congenital anomaly"
          }
        ]
      }
    },
    {
      "resourceType": "ValueSet",
      "id": "IMMZ.D.DE115",
      "url": "http://smart.who.int/immunizations/ValueSet/IMMZ.D.DE115",
      "name": "IMMZ_D_DE115",
      "title": "IMMZ.D.DE115 ValueSet for Reaction outcome",
      "status": "active",
      "description": "ValueSet for Reaction outcome for IMMZ.D.DE115",
      "compose": {
        "include": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "concept": [
              {
                "code": "DE116",
                "display": "Died"
              },
              {
                "code": "DE117",
                "display": "Recovered"
              },
              {
                "code": "DE118",
                "display": "Recovered with sequelae"
              },
              {
                "code": "DE119",
                "display": "Recovering"
              },
              {
                "code": "DE120",
                "display": "Not recovered"
              },
              {
                "code": "DE121",
                "display": "Unknown"
              }
            ]
          }
        ]
      },
      "expansion": {
        "timestamp": "2025-06-25T16:39:07.092Z",
        "contains": [
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE116",
            "display": "Died"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE117",
            "display": "Recovered"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE118",
            "display": "Recovered with sequelae"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE119",
            "display": "Recovering"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE120",
            "display": "Not recovered"
          },
          {
            "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
            "code": "DE121",
            "display": "Unknown"
          }
        ]
      }
    }
  ],
  "extension": [
    {
      "url": "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-targetStructureMap",
      "valueCanonical": "http://smart.who.int/immunizations/StructureMap/IMMZ.D17.QRToBundle"
    }
  ],
  "url": "http://smart.who.int/immunizations/Questionnaire/QIMMZD17",
  "version": "0.2.0",
  "title": "IMMZ.D17.Report AEFI",
  "status": "draft",
  "subjectType": [
    "Patient"
  ],
  "date": "2025-08-08T19:12:11+00:00",
  "publisher": "WHO",
  "contact": [
    {
      "name": "WHO",
      "telecom": [
        {
          "system": "url",
          "value": "http://who.int"
        }
      ]
    }
  ],
  "description": "Questionnaire for IMMZ.D17.Report AEFI",
  "item": [
    {
      "linkId": "reactionReported",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE92"
        },
        {
          "system": "http://id.who.int/icd/release/11/mms",
          "code": "PK81.7",
          "display": "Injection or infusion for therapeutic or diagnostic purposes associated with injury or harm in therapeutic use"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "418799008",
          "display": "Finding reported by subject or history provider (finding)"
        }
      ],
      "text": "Reaction reported",
      "type": "boolean",
      "required": false,
      "repeats": false
    },
    {
      "extension": [
        {
          "url": "http://hl7.org/fhir/StructureDefinition/maxValue",
          "valueDate": "2100-01-01",
          "_valueDate": {
            "extension": [
              {
                "url": "http://hl7.org/fhir/StructureDefinition/cqf-calculatedValue",
                "valueString": "today()"
              }
            ]
          }
        }
      ],
      "linkId": "reactionDate",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE93"
        },
        {
          "system": "http://loinc.org",
          "code": "30953-4",
          "display": "Date and time of onset of vaccination adverse event"
        }
      ],
      "text": "Reaction date",
      "type": "date",
      "enableWhen": [
        {
          "question": "reactionReported",
          "operator": "=",
          "answerBoolean": true
        }
      ],
      "required": true,
      "repeats": false
    },
    {
      "linkId": "reactionManifestation",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE95"
        },
        {
          "system": "http://id.who.int/icd/release/11/mms",
          "code": "NE80.3",
          "display": "Other serum reactions. This code includes 'Complications of vaccination, serum reaction'. A more specific code may be selected based on the documented reaction/manifestation"
        }
      ],
      "text": "Reaction manifestation",
      "type": "choice",
      "enableWhen": [
        {
          "question": "reactionReported",
          "operator": "=",
          "answerBoolean": true
        }
      ],
      "required": true,
      "repeats": false,
      "answerValueSet": "#IMMZ.D.DE95"
    },
    {
      "linkId": "typeOfReaction",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE107"
        }
      ],
      "text": "Type of reaction",
      "type": "choice",
      "enableWhen": [
        {
          "question": "reactionReported",
          "operator": "=",
          "answerBoolean": true
        }
      ],
      "required": true,
      "repeats": false,
      "answerValueSet": "#IMMZ.D.DE107"
    },
    {
      "linkId": "otherImportantMedicalEvent",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE113"
        }
      ],
      "text": "Other important medical event (specify)",
      "type": "string",
      "required": false,
      "repeats": false
    },
    {
      "linkId": "reactionOutcome",
      "code": [
        {
          "system": "http://smart.who.int/immunizations/CodeSystem/IMMZ.D",
          "code": "DE115"
        },
        {
          "system": "http://snomed.info/sct",
          "code": "293104008",
          "display": "Adverse reaction to component of vaccine product (disorder)"
        }
      ],
      "text": "Reaction outcome",
      "type": "choice",
      "enableWhen": [
        {
          "question": "reactionReported",
          "operator": "=",
          "answerBoolean": true
        }
      ],
      "required": true,
      "repeats": false,
      "answerValueSet": "#IMMZ.D.DE115"
    }
  ]
}