7.4: Notify Public Health Immunization Registry (IIS) of Update from Adverse Event

Overview of Scenario

The EHR or other clinical software system notifies the public health immunization registry (IIS) of an update due to an adverse event.

Example of Scenario

24 hours after her live, attenuated influenza vaccine, Juana Maria Gonzales Morales had fever and diarrhea. The potential adverse event occurred 24 hours after the vaccine was administered. Dr. Smith updates the report to the public health immunization registry (IIS).


Some of the products evaluated will submit an updated immunization record to an immunization registry (IIS) if the provider updates the vaccine administration record to include the adverse event either as a structured data attribute or as an administration note. Some of the vendors indicated their customers report some IIS’ do not accept these updated reports or reports of adverse events in the HL7 Send Unsolicited Immunization Update Using a VXU (Z22). The vocabularies used to record an adverse event within the products differ from the vocabularies identified for reporting adverse events in the HL7 Version 2.5.1 Implementation Guide for Immunization Messaging.

The purpose of updating the IIS is to ensure public health is aware of events related to specific vaccines and also so other providers receiving the patient’s immunization history from the registry are also aware of the previous reaction. This is a patient safety issue to make providers aware of the adverse events to reduce the risk of repeat events. Some vendors report that registries will only accept updated reports containing adverse events if the match one of nine specific adverse events based on a value set (http://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.3289). The vendors also report that when providers submit updated reports containing comments about adverse events not in the value set, the reports are often rejected. Further, previous adverse events are not generally included in immunization histories returned to providers in response to queries (Section 5.5, requirement 2.2).

Collaboration among public health immunization registries, EHR vendors and providers will help to harmonize expectations and improve communications.

  • Vendor Perspectives. Vendors should consider collaborating with providers and public health immunization registries to harmonize needs and workflow for adverse event notifications to the registry.
  • Provider and Implementer Perspectives. Providers should consider collaborating with EHR vendors and public health immunization registries to harmonize needs and workflow for adverse event notifications to the registry.


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Data Elements

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