# Patient Test Record: MMRMoreThan730DAfterDOB NUMERFail

Patient
MMRMoreThan730DAfterDOB NUMERFail
Sex
M
Date of birth
2024-12-31T01:00:00+00:00
Date of expiration
None
Race
1002-5
Ethnicity
2186-5
Insurance Providers
1
Patient IDs
82
Address
Telecom
(HP) 555-555-2003

### QDM::EncounterPerformed

Description
Codes
Time
Fields/Results
Encounter, Performed: Office Visit
Codes:
SNOMEDCT: 185463005
Time Elements:
Relevant Period Start: 2026-10-12T13:05:00.000+00:00
Relevant Period End: 2026-10-12T13:05:00.000+00:00
Other Fields:
Length Of Stay: 0 days

### QDM::ImmunizationAdministered

Description
Codes
Time
Fields/Results
Immunization, Administered: Inactivated Polio Vaccine (Ipv)
Codes:
CVX: 10
Time Elements:
Relevant Date/Time: 2025-01-02T07:45:00.000+00:00
Other Fields:
Immunization, Administered: Rotavirus Vaccine (2 Dose Schedule)
Codes:
CVX: 119
Time Elements:
Relevant Date/Time: 2025-03-03T08:00:00.000+00:00
Other Fields:
Immunization, Administered: Hepatitis A Vaccine
Codes:
CVX: 83
Time Elements:
Relevant Date/Time: 2025-03-03T08:00:00.000+00:00
Other Fields:
Immunization, Administered: Pneumococcal Conjugate Vaccine
Codes:
CVX: 133
Time Elements:
Relevant Date/Time: 2025-04-02T16:45:00.000+00:00
Other Fields:
Immunization, Administered: Pneumococcal Conjugate Vaccine
Codes:
CVX: 133
Time Elements:
Relevant Date/Time: 2025-04-02T16:45:00.000+00:00
Other Fields:
Immunization, Administered: Inactivated Polio Vaccine (Ipv)
Codes:
CVX: 10
Time Elements:
Relevant Date/Time: 2025-04-04T08:00:00.000+00:00
Other Fields:
Immunization, Administered: D Ta P Vaccine
Codes:
CVX: 106
Time Elements:
Relevant Date/Time: 2025-04-13T08:00:00.000+00:00
Other Fields:
Immunization, Administered: D Ta P Vaccine
Codes:
CVX: 106
Time Elements:
Relevant Date/Time: 2025-04-15T07:00:00.000+00:00
Other Fields:
Immunization, Administered: Rotavirus Vaccine (2 Dose Schedule)
Codes:
CVX: 119
Time Elements:
Relevant Date/Time: 2025-06-03T09:45:00.000+00:00
Other Fields:
Immunization, Administered: HiB Vaccine (3 dose schedule)
Codes:
CVX: 49
Time Elements:
Relevant Date/Time: 2025-06-05T09:45:00.000+00:00
Other Fields:
Immunization, Administered: Pneumococcal Conjugate Vaccine
Codes:
CVX: 133
Time Elements:
Relevant Date/Time: 2025-06-17T09:00:00.000+00:00
Other Fields:
Immunization, Administered: HiB Vaccine (3 dose schedule)
Codes:
CVX: 49
Time Elements:
Relevant Date/Time: 2025-07-05T09:00:00.000+00:00
Other Fields:
Immunization, Administered: Varicella Zoster Vaccine (Vzv)
Codes:
CVX: 21
Time Elements:
Relevant Date/Time: 2025-08-08T13:15:00.000+00:00
Other Fields:
Immunization, Administered: Pneumococcal Conjugate Vaccine
Codes:
CVX: 133
Time Elements:
Relevant Date/Time: 2025-08-08T13:15:00.000+00:00
Other Fields:
Immunization, Administered: Inactivated Polio Vaccine (Ipv)
Codes:
CVX: 110
Time Elements:
Relevant Date/Time: 2025-10-10T09:45:00.000+00:00
Other Fields:
Immunization, Administered: Pneumococcal Conjugate Vaccine
Codes:
CVX: 133
Time Elements:
Relevant Date/Time: 2025-11-13T09:45:00.000+00:00
Other Fields:
Immunization, Administered: HiB Vaccine (4 dose schedule)
Codes:
CVX: 120
Time Elements:
Relevant Date/Time: 2025-12-12T08:00:00.000+00:00
Other Fields:
Immunization, Administered: D Ta P Vaccine
Codes:
CVX: 106
Time Elements:
Relevant Date/Time: 2026-03-02T12:00:00.000+00:00
Other Fields:
Immunization, Administered: D Ta P Vaccine
Codes:
CVX: 106
Time Elements:
Relevant Date/Time: 2026-06-12T09:45:00.000+00:00
Other Fields:
Immunization, Administered: Hepatitis B Vaccine
Codes:
CVX: 08
Time Elements:
Relevant Date/Time: 2026-07-07T01:00:00.000+00:00
Other Fields:
Immunization, Administered: Influenza Vaccine
Codes:
CVX: 140
Time Elements:
Relevant Date/Time: 2026-07-07T17:00:00.000+00:00
Other Fields:
Immunization, Administered: Influenza Vaccine
Codes:
CVX: 141
Time Elements:
Relevant Date/Time: 2026-08-07T18:00:00.000+00:00
Other Fields:
Immunization, Administered: Hepatitis B Vaccine
Codes:
CVX: 08
Time Elements:
Relevant Date/Time: 2026-08-28T01:00:00.000+00:00
Other Fields:
Immunization, Administered: Hepatitis B Vaccine
Codes:
CVX: 08
Time Elements:
Relevant Date/Time: 2026-12-12T07:20:00.000+00:00
Other Fields:
Immunization, Administered: HiB Vaccine (4 dose schedule)
Codes:
CVX: 120
Time Elements:
Relevant Date/Time: 2026-12-12T08:00:00.000+00:00
Other Fields:
Immunization, Administered: Measles, Mumps And Rubella (Mmr) Vaccine
Codes:
CVX: 03
Time Elements:
Relevant Date/Time: 2028-06-01T09:00:00.000+00:00
Other Fields:

### QDM::PatientCharacteristicSex

Description
Codes
Time
Fields/Results
Patient Characteristic Sex: ONCAdministrativeSex
Codes:
AdministrativeGender: M
Time Elements:
Other Fields:

### QDM::PatientCharacteristicBirthdate

Description
Codes
Time
Fields/Results
Patient Characteristic Birthdate: Birth date
Codes:
LOINC: 21112-8
Time Elements:
Birth Date/Time: 2024-12-31T01:00:00.000+00:00
Other Fields:

### QDM::PatientCharacteristicRace

Description
Codes
Time
Fields/Results
Patient Characteristic Race: Race
Codes:
CDCREC: 1002-5
Time Elements:
Other Fields:

### QDM::PatientCharacteristicEthnicity

Description
Codes
Time
Fields/Results
Patient Characteristic Ethnicity: Ethnicity
Codes:
CDCREC: 2186-5
Time Elements:
Other Fields:

### QDM::PatientCharacteristicPayer

Description
Codes
Time
Fields/Results
Codes:
Source of Payment Typology: 1
Time Elements:
Relevant Period Start: 2024-12-31T01:00:00.000+00:00
Other Fields: