If you are applying for a Green Card through adjustment of status (Form I‑485), the medical examination is not optional—and neither are the vaccinations. U.S. immigration law requires that you receive all age‑appropriate immunizations recommended by the Advisory Committee on Immunization Practices (ACIP) before a USCIS‑designated civil surgeon can sign off on your Form I‑693. The stakes are high: an incomplete vaccination record is one of the most common reasons for Requests for Evidence (RFEs) that delay Green Card adjudication by months. However, the requirement is more flexible than many applicants realize—you do not need to have completed every multi‑dose series before your exam; you only need to have started each required vaccine. Missing shots can be administered during the exam itself, and you can finish the remaining doses after you receive your Green Card. Understanding exactly which vaccines are required, how age affects the list, and what documentation you need can save you from costly delays and unnecessary repeat exams.
Critical Rule: As of August 2026, the CDC immigration vaccination schedule requires protection against 15 diseases. The COVID‑19 vaccine is no longer required as of January 22, 2025. Only the first dose of a multi‑dose series is required before the civil surgeon can sign Form I‑693. The civil surgeon determines which vaccines apply to you based on your age at the time of the exam, following the CDC‘s age‑by‑age table. A properly completed Form I‑693 signed on or after November 1, 2023, is valid for the duration of your pending I‑485 application—it does not expire as long as your case remains pending.
Which Vaccines Are Required for Green Card Adjustment of Status?
The CDC immigration vaccination schedule, effective March 11, 2025, covers 15 diseases. Not every vaccine applies to every applicant—the civil surgeon determines which ones you need based on your age and medical history. The following table lists all 15 diseases and the corresponding vaccines.
| Disease | Vaccine | Typical Age Group |
|---|---|---|
| Diphtheria | DTaP/Tdap (combined with tetanus and pertussis) | All ages |
| Tetanus | DTaP/Tdap | All ages |
| Pertussis (whooping cough) | DTaP/Tdap | All ages |
| Polio | IPV (inactivated polio vaccine) | All ages |
| Measles | MMR (combined with mumps and rubella) | All ages |
| Mumps | MMR | All ages |
| Rubella | MMR | All ages |
| Rotavirus | Rotavirus vaccine | Infants (under 8 months) |
| Haemophilus influenzae type b | Hib vaccine | Infants and children under 5 |
| Hepatitis A | Hepatitis A vaccine | Children and certain adults |
| Hepatitis B | Hepatitis B vaccine | All ages |
| Meningococcal disease | Meningococcal vaccine (ACWY) | Adolescents (age 11–23) |
| Varicella (chickenpox) | Varicella vaccine | All ages |
| Pneumococcal disease | Pneumococcal vaccine (PCV/PPSV) | Infants, children, and adults 65+ |
| Influenza (seasonal flu) | Influenza vaccine | All ages (during flu season) |
Some vaccines are administered as combination shots—DTaP/Tdap covers diphtheria, tetanus, and pertussis in one series, while MMR covers measles, mumps, and rubella. The civil surgeon will check your records against Table 1 of the CDC‘s Technical Instructions to determine which of these vaccines are required for you.
⚠️ Important: The influenza vaccine is required only during flu season—typically September through March (varies by region). If your exam occurs outside flu season and the vaccine is not available in your area, the civil surgeon will document “Flu vaccine not available“ on Form I‑693, and you will not be penalized. If the exam occurs during flu season and you have not received the vaccine, the civil surgeon can administer it on site.
How Age Determines Which Vaccines You Need
The required vaccine list is not a one‑size‑fits‑all checklist. The civil surgeon uses your age at the time of the medical evaluation to determine which vaccines are age‑appropriate. Different age groups have different requirements:
- Infants (under 12 months): Rotavirus and Hib are typically required in addition to the core vaccines. Pneumococcal vaccine is also recommended for this age group.
- Children (1–10 years): The full series of DTaP, IPV, MMR, varicella, hepatitis A, and hepatitis B are required. Rotavirus and Hib may no longer be required depending on the child‘s exact age.
- Adolescents (11–23 years): Meningococcal vaccine is added to the requirement list. A Tdap booster is also required if more than 10 years have passed since the last tetanus‑containing vaccine.
- Adults (24–64 years): MMR, varicella, Tdap (or Td if pertussis is contraindicated), hepatitis B, and polio are generally required. Influenza is required during flu season.
- Older adults (65+): Pneumococcal vaccine is added to the requirement list.
- Pregnant applicants: Certain live vaccines (MMR, varicella) may be contraindicated during pregnancy. The civil surgeon will follow CDC guidance on deferring these vaccines until after delivery.
If you have documented immunity through a prior infection (e.g., you had chickenpox as a child), the civil surgeon may accept that as proof instead of the vaccine. For varicella, the physician can mark “VH“ (varicella history) on Form I‑693 if you provide a reliable medical history.
What If You Are Missing a Vaccine? Only the First Dose Is Required
One of the most misunderstood rules is that you do not need to have completed every multi‑dose series before the civil surgeon can sign Form I‑693. The CDC‘s Technical Instructions state that only the first dose of a multi‑dose series is required before the medical examination is considered complete. This means:
- MMR: You need the first dose. The second dose can be given after you receive your Green Card.
- Hepatitis B: You need the first dose. The remaining doses can be completed later.
- Varicella: You need the first dose (unless you have documented immunity).
- Hepatitis A: You need the first dose if it is age‑appropriate.
If you are missing any required vaccine, the civil surgeon can administer it during the exam. Most civil surgeons stock the common vaccines and can give you the shot on the spot. If the physician does not carry a specific vaccine, they will instruct you to get it elsewhere and return with the documentation.
For influenza, if your exam falls during flu season, you must receive the current seasonal flu vaccine unless it is not available in your area.
✅ Pro Tip: Before your medical exam, obtain your complete vaccination records—including dates, lot numbers, and provider signatures—and bring them to the civil surgeon. If your records are missing lot numbers or are illegible, the physician may require titers (blood tests) to prove immunity, which adds cost and time. A complete record can save you from unnecessary testing.
Form I‑693: Submission Rules and Validity Period
Your vaccination history is documented on Form I‑693, Report of Immigration Medical Examination and Vaccination Record. Only a USCIS‑designated civil surgeon can complete and sign this form. The civil surgeon seals the completed form in an envelope, and you must submit it with your Form I‑485.
Key submission rules as of August 2026:
- Concurrent filing required: Effective December 2, 2024, you must submit Form I‑693 (or a partial vaccination record) with your Form I‑485. If you file I‑485 without the medical exam, USCIS may reject your application.
- Online filing: If you file Form I‑485 online, you must open the sealed envelope from the civil surgeon and upload the completed Form I‑693. Keep the original envelope until USCIS makes a final decision.
- Mail filing: Submit Form I‑693 in the original sealed envelope with your I‑485 package.
Validity period: A Form I‑693 properly completed and signed by a civil surgeon on or after November 1, 2023 remains valid for the duration of your pending I‑485 application. It does not expire as long as your case remains pending. However, if your I‑485 is denied or withdrawn, that Form I‑693 is no longer valid. Forms signed before November 1, 2023, retain validity for two years from the date of the civil surgeon‘s signature.
Vaccine Waivers: Exemptions Are Rare but Possible
USCIS allows vaccination waivers in limited circumstances. The two types of exemptions are:
- Medical exemption: If a vaccine is medically contraindicated for you (e.g., severe allergy to a vaccine component, pregnancy, or immunocompromised status), the civil surgeon can document the exemption on Form I‑693. You must provide supporting documentation from your physician.
- Religious or moral exemption: You may request a waiver based on sincerely held religious beliefs or moral convictions. This requires a separate application and is rarely granted. The waiver request is decided by USCIS, not the civil surgeon, and can take months to process.
It is important to note that waivers are not automatic. If you refuse a required vaccine without a valid exemption, the civil surgeon will mark your vaccination record as incomplete, and your I‑485 may be delayed or denied.
Common Vaccination Mistakes That Delay Your Green Card
Even with a clear understanding of the requirements, applicants make errors that lead to RFEs, medical holds, and months of delay. Avoid these pitfalls:
- Submitting incomplete vaccination records: A record that lists “MMR“ without dates, lot numbers, or provider signatures is not acceptable. The civil surgeon needs specific administration dates to verify the ACIP schedule.
- Failing to get the flu vaccine during flu season: If your exam falls between September and March (varies by region) and you have not received the flu shot, the civil surgeon will mark you as non‑compliant. You can get the vaccine on site, but it adds time and cost.
- Assuming a titer is always accepted: Titers (blood tests for immunity) are accepted only for MMR, varicella, hepatitis A, and hepatitis B. For Tdap, polio, influenza, pneumococcal, and meningococcal, a titer is not a valid substitute—you must have the actual vaccine.
- Not translating foreign vaccination records: If your records are in a language other than English, you must provide a certified English translation. The civil surgeon cannot accept untranslated documents.
- Waiting until the last minute to get missing vaccines: While the civil surgeon can administer vaccines on site, some vaccines require multiple doses with specific intervals (e.g., MMR requires 28 days between doses). If you need a second dose before the exam, plan ahead.
- Opening the sealed medical envelope: Once the civil surgeon seals Form I‑693, you must not open it. An opened envelope is invalid, and you will need to pay for a new exam.
Frequently Asked Questions
Q: What vaccines are required for a Green Card adjustment of status in 2026?
A: The CDC immigration vaccination schedule covers 15 diseases: diphtheria, tetanus, pertussis, polio, measles, mumps, rubella, rotavirus, Haemophilus influenzae type b, hepatitis A, hepatitis B, meningococcal disease, varicella, pneumococcal disease, and influenza. The COVID‑19 vaccine is no longer required. The civil surgeon determines which of these apply to you based on your age.
Q: Do I need to be fully vaccinated before my medical exam?
A: No—you only need to have started each required vaccine series. The first dose of a multi‑dose series is sufficient for the civil surgeon to sign Form I‑693. You can complete the remaining doses after you receive your Green Card.
Q: Is the COVID‑19 vaccine still required for the immigration medical exam?
A: No. USCIS waived the COVID‑19 vaccination requirement effective January 22, 2025. The CDC removed it from the Technical Instructions on March 11, 2025. You do not need to provide COVID‑19 vaccination documentation for Form I‑693.
Q: Can I use a titer (blood test) instead of a vaccine?
A: Yes, but only for certain vaccines. Titers are accepted for MMR, varicella, hepatitis A, and hepatitis B. For Tdap, polio, influenza, pneumococcal, and meningococcal, a titer is not accepted—you must receive the vaccine.
Q: How long is Form I‑693 valid for?
A: A Form I‑693 signed on or after November 1, 2023, remains valid for the duration of your pending I‑485 application. It does not expire as long as your case is pending. If your I‑485 is denied or withdrawn, the form is no longer valid.
Q: What if I am pregnant and cannot get certain vaccines?
A: Live vaccines (MMR, varicella) are generally contraindicated during pregnancy. The civil surgeon will follow CDC guidance and defer those vaccines until after delivery. You will need to complete them after you give birth and provide updated documentation to USCIS.
Q: Can a civil surgeon administer vaccines during the exam?
A: Yes—most civil surgeons stock the required vaccines and can administer missing doses on site. If they do not carry a specific vaccine, they will instruct you to get it elsewhere and return with the documentation.