EDI 500 Format
ISA*01*0000000000*01*0000000000*ZZ*ABCDEFGHIJKLMNO*ZZ*123456789012345*101127*1719*U*00400*000003438*0*P*>
GS*MM*1234567890 *999999999 *20120126*1211*1*T*004010
ST*500*0001
BGN*00*Reference Identification*20120224*1653*01*Reference Identification*01*1*00
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01
N2*Name*Name
N3*Address Information*Address Information
N3*Address Information*Address Information
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier
REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe
DTM*001*20120224*1653*01*CC*Date Time Period
QTY*01*338*01235633519201128581152842409811129543230429611133956323853130233291932542
TRN*1*Reference Identification*Originatin*Reference Identification
LM*10*Source Subquali
LQ*0*Industry Code
HL*1**1*0
LM*10*Source Subquali
LQ*0*Industry Code
DTM*001*20120224*1653200*01*CC*Date Time Period
REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification
QTY*01*2267278*0122606031511872347917186911541866338742381755918391207542218571102747856111226891
MTX*AAA*Message Text*Message Text*AA
LIN*Assigned Identificat*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID*A1*Product/Service ID
PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN
QTY*01*124654*0118544461532399272422056113031733523289411703729949666032776331312271112876
DTM*001*20120224*1653*01*CC*Date Time Period
REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification
MEA*9L*1*3228614419*0127830233770481189720916616132759628026158268616566167397200102218091*3001922*232841920162*01**1S*BM
TRN*1*Reference Identification*Originatin*Reference Identification
MTX*AAA*Message Text*Message Text*AA
NM1*01*1*Name Last or Organization Name*Name First*Name Middle*Name Prefi*Name Suffi*1*Identification Code*01*01
N2*Name*Name
N3*Address Information*Address Information
N4*City Name*ST*POSTAL CODE*COU*A*Location Identifier
REF*01*Reference Identification*Description*01Reference Identification1Reference Identification1Reference Identification
PER*1A*Name*AA*Communication Number*AA*Communication Number*AA*Communication Number*Contact Inquiry Refe
DTM*001*20120224*1653200*01*CC*Date Time Period
DMG*CC*Date Time Period*A*A*7*1*COU*1*26502
MEA*9L*1*2182276832*015534748570121786815219126547106322517318632551322215242306*28081*26237270481401317836*01**1S*BM
PWK*01*1*6*01*1*Identification Code*Description*11111*AR
TRN*1*Reference Identification*Originatin*Reference Identification
QTY*01*7713418*012423118028241459517287127331115626117842467417141901124
LM*10*Source Subquali
LQ*0*Industry Code
PID*F*01*10*Product Desc*Description*1S*Source Subquali*N*LAN
DTM*001*20120224*16532100*01*CC*Date Time Period
QTY*01*2881116*0132205192126491220315591123988171282431792657772763111271261683495951
MTX*AAA*Message Text*Message Text*AA
DTM*001*20120224*165321*01*CC*Date Time Period
CTT*214129*456275*85191521*01*7267276*01*Description
SE*50*0001
GE*1*1
IEA*1*000000165
EDI 500 Specification
This X12 Transaction Set contains the format and establishes the data contents of the Medical Event Reporting Transaction Set (500) for use within the context of an Electronic Data Interchange (EDI) environment. This standard can be used to make voluntary, mandatory, baseline, annual and semi-annual reports on medication and medical device adverse effects and product problems.
