CDC Endorsed Patient Demographic and Vaccination Event Data Elements

The CDC endorsed data elements represent the data elements that are needed by an IIS to record patient demographics and vaccination events to meet the IIS Functional Standards v4.0. An IIS should 

store the CDC endorsed data elements listed below if the elements are sent from an external information system and meet the IIS’s data quality criteria. This list does not include all data elements 

external information systems such as EHRs, vital records, practice management or billing systems are expected to send to an IIS. The list may not include all data elements an IIS produces, stores or 

sends. Data elements may be derived and architectural solution may differ among IIS. 

Patient Demographic Data Elements 

Date of history of vaccine preventable disease Patient ID 

Ethnicity Patient ID: type 

History of disease/titer IIS Patient ID 

Mother’s name: first Patient multiple birth indicator 

Mother’s name: middle Patient name: first 

Mother’s name: last Patient name: middle 

Mother’s name: maiden last Patient name: last 

Patient address: county of residence Patient primary language 

Patient address: city Patient status indicator-provider level 

Patient address: country Patient status-jurisdiction level 

Patient address: state Patient telephone number 

Patient address: street Patient telephone number type 

Patient address: zip code Protection Indicator 

Patient alias name: first Protection indicator effective date 

Patient alias name: middle Reminder recall status 

Patient alias name: last Reminder recall status effective date 

Patient birth order Race 

Patient birth state Responsible person name: first 

Patient date of birth Responsible person name: middle 

Patient e-mail address Responsible person name: last 

Patient gender Responsible person relationship to patient 

Key 

Vaccination Event Data Elements 

Vaccination Data Elements Provider Data Elements 

Contraindications/precautions Vaccine ordering provider (person) 

Contraindications/precautions observation date Vaccine administering provider suffix 

Dose level eligibility.ꞎ Vaccine administering provider (person) 

Exemptions/refusals date 

Exemptions/refusals reason Facility Identifier Data Elements 

Vaccination administration date Administered at location 

Vaccine dose volume Sending organization 

Vaccine dose volume units Responsible organization 

Vaccination event record type (administered/historical) 

Vaccine funding source (dose level public/private indicator)ꞎꞎ

Vaccine expiration date 

Vaccine lot number 

Vaccine manufacturer name 

Vaccine product 

Vaccine route of administration1 

Vaccine site of administration1 

IIS vaccination event ID 

Vaccination event ID 

Vaccine information statement1 

Vaccine information statement given date1 

Yellow Data element is new for IIS Functional Standards v4.0. 

ꞎDefinition: the program that should pay for a given immunization, based on the characteristics of the patient and the type of vaccine administered. Eligibility is captured for each dose. 

ꞎꞎ Definition: the funding source of the vaccine administered. Identifies the administered vaccine as publically funded, privately funded, or with other jurisdiction specific funding. 

Centers for Disease Control and Prevention Immunization Information Systems Support Branch March, 2018 

1 Data element should be captured in the IIS if the IIS is used as the primary vaccination event record (e.g., mass vaccination clinic).