If you were never vaccinated as a child and are now applying for a U.S. green card or immigrant visa, you are far from alone—and it does not mean your application is doomed. The U.S. immigration medical examination, documented on Form I-693 (or the overseas equivalent), requires proof of vaccination against a specific list of preventable diseases. But the system is designed to accommodate applicants who have no vaccination records at all. The civil surgeon or panel physician will assess your age, review any available documentation, and administer the vaccines you need—often on the same day as your exam. This guide explains exactly what happens when you arrive with no childhood vaccination history, what vaccines you will need, what it will cost, and how to navigate the process without unnecessary delays.
Key Rule: Having no childhood vaccination records does not make you inadmissible. The civil surgeon or panel physician will determine which vaccines are age-appropriate and administer the required doses during your medical exam. You are only required to receive at least one dose of each age-appropriate vaccine at the time of the exam; you do not need to complete the entire series before the civil surgeon can sign your Form I-693.
Which Vaccines Are Required for U.S. Immigration?
The list of required vaccines is set by U.S. law and the CDC, and it applies to all immigrant visa applicants and adjustment of status applicants. The specific vaccines you need depend on your age at the time of the medical exam. The following vaccines are currently required for immigration purposes:
- MMR (Measles, Mumps, Rubella) – required for individuals born in 1957 or later
- Tdap/Td (Tetanus, Diphtheria, Pertussis) – required for all ages, with a Tdap booster within the last 10 years for adults
- Polio – required for all ages
- Varicella (Chickenpox) – required for children and adults
- Hepatitis B – required for adults up to age 59
- Hepatitis A – required for children up to age 18
- Influenza – seasonal requirement (during flu season) for individuals 6 months and older
- Pneumococcal – required for adults born before 1956
- Meningococcal – required for adolescents and young adults
- Rotavirus – required for young children
- Haemophilus influenzae type B (Hib) – required for young children
As of January 2025, the COVID-19 vaccine is no longer required for immigration medical exams.
For children, additional vaccines such as rotavirus, Hib, and pneumococcal conjugate may be required depending on their age. The civil surgeon will use the CDC's Table 1 to determine exactly which vaccines are age-appropriate for you.
What Happens at the Exam If You Have No Vaccination Records?
Arriving without any vaccination records is common and fully manageable. Here is exactly what happens during your immigration medical exam:
- Vaccination assessment: The civil surgeon or panel physician will review your age, medical history, and any documentation you were able to bring—even incomplete or unofficial records.
- Determination of needed vaccines: Based on your age and the CDC requirements, the surgeon will determine which vaccines are required and which you are missing.
- Administration of vaccines: The surgeon can administer the required vaccines on-site during your exam. You are only required to receive at least one dose of each age-appropriate vaccine at the time of the exam.
- Completion of Form I-693: The surgeon will document the vaccines you received and note any vaccines that are "not age appropriate" or "not medically appropriate".
- Follow-up for vaccine series: If you need additional doses to complete a vaccine series (e.g., a second MMR dose or a third Hepatitis B dose), you are encouraged to follow up with your primary care provider after the exam.
The civil surgeon will provide you with a sealed envelope containing your completed Form I-693. If you file Form I-485 by mail, you must submit this sealed envelope with your application. If you file online, you must open the envelope, upload the form, and keep the original for your records.
Costs, Timing, and What to Expect
The cost of the immigration medical exam varies widely, but you should budget for both the exam fee and the cost of any vaccines you receive during the appointment.
| Cost Component | Estimated Range | Notes |
|---|---|---|
| Medical exam (civil surgeon) | $200 – $500 | Varies by location and provider |
| Vaccines administered during exam | $50 – $300+ | Depends on how many vaccines you need |
| Titer tests (if needed) | $50 – $200 | Blood tests to check for immunity |
The exam typically takes one visit, though additional testing (such as a TB skin test or chest X-ray) may require a follow-up appointment. Lab results usually take 2 to 4 days to process. If you receive vaccines during the exam, the civil surgeon can complete and sign your Form I-693 immediately after the required doses are administered.
If you are applying for an immigrant visa abroad, the panel physician will follow similar procedures but will use the DS-3025 Vaccination Documentation Worksheet instead of Form I-693.
Vaccine Waivers and Exemptions
If you cannot receive a particular vaccine for medical reasons, you may qualify for a blanket waiver that does not require a separate application. The civil surgeon will determine if a vaccine is "not medically appropriate" for you based on:
- Not age-appropriate: The vaccine is not required for your age group.
- Medical contraindication: You have a condition that would make the vaccine life-threatening (e.g., severe allergic reaction to a previous dose, pregnancy).
- Insufficient time interval: You have started the vaccine series but cannot complete it before the exam.
- Not flu season: For the influenza vaccine only, if it is not flu season or the vaccine is unavailable.
If the civil surgeon marks a vaccine as "not medically appropriate" on Form I-693, USCIS will automatically waive that vaccine requirement. You do not need to file a separate waiver request.
For religious or moral objections to vaccines, a separate waiver application is required. This is a more complex process and is not automatically granted. You must demonstrate that you have sincere religious or moral beliefs that oppose vaccination.
What NOT to Do: Common Mistakes to Avoid
When you have no childhood vaccination records, the process is straightforward—but these common mistakes can cause unnecessary delays:
- Postponing the exam to "find" records. You do not need to find your records. The civil surgeon can administer the vaccines you need during the exam. Delaying your exam only delays your entire green card application.
- Getting vaccines from your regular doctor before the exam. While you can do this, the civil surgeon must still verify and document them on Form I-693. If you get vaccines elsewhere, bring the official records to the exam—otherwise, the civil surgeon may need to administer them again.
- Assuming one dose is enough for all vaccines. You only need one dose at the time of the exam to complete Form I-693. However, you are encouraged to complete the full series after the exam.
- Not bringing any documentation at all. Even if you have no official records, bring whatever you have—school health forms, prescription records, or photos of vaccination cards. The civil surgeon may be able to use them.
- Forgetting your government-issued ID. You must bring a valid passport or driver's license to the exam.
- Filing Form I-485 before your exam is complete. As of December 2024, you must submit Form I-693 with your Form I-485. Do not file your green card application until your medical exam is finished and you have the sealed envelope in hand.
Frequently Asked Questions
Q: Do I need to complete the full vaccine series before the civil surgeon can sign my Form I-693?
A: No. You are only required to receive at least one dose of each age-appropriate vaccine at the time of the exam. The civil surgeon can sign your Form I-693 after you receive the first dose of each required vaccine. You can complete the remaining doses after your green card is approved.
Q: What if I have a medical condition that prevents me from getting a vaccine?
A: The civil surgeon will assess whether the vaccine is "not medically appropriate" for you due to a contraindication (e.g., severe allergy, pregnancy). If so, they will mark this on Form I-693, and USCIS will automatically waive that vaccine requirement. You do not need to file a separate waiver application.
Q: Will the civil surgeon accept vaccination records from another country?
A: Yes. The civil surgeon can accept official vaccination records from any country, as long as they include dates and are legible. If the records are not in English, you should provide a certified translation.
Q: How much does it cost to get vaccines during the immigration medical exam?
A: The cost varies widely by provider and location. You should expect to pay anywhere from $50 to $300+ for vaccines administered during the exam, in addition to the exam fee ($200–$500). Ask the civil surgeon's office for a cost estimate before your appointment.
Q: I was born before 1957. Do I still need the MMR vaccine?
A: Generally, no. Individuals born before 1957 are considered to have natural immunity to measles, mumps, and rubella due to widespread exposure before the vaccine was available. The civil surgeon will mark MMR as "not age-appropriate" on your Form I-693.
Q: What if my child was never vaccinated—will they be denied a green card?
A: No. Children who have never been vaccinated will receive the required vaccines during the medical exam, just like adults. The civil surgeon will administer age-appropriate vaccines and complete Form I-693. The child will not be denied simply because they were never vaccinated as a child.
Q: Is the COVID-19 vaccine still required for the immigration medical exam?
A: No. As of January 22, 2025 (USCIS) and March 11, 2025 (CDC), the COVID-19 vaccine is no longer required for immigration medical exams.