Tdap on I-693: How U.S. Applicants Avoid Delays and Finish in 3 Days

Tdap or Td is generally required on Form I-693 for applicants age 11 and older, with the exact vaccine depending on prior documented history and age. Your civil surgeon must follow CDC Technical Instructions when deciding which dose you need, and a booster is typically required if your last documented dose was more than 10 years ago. Verbal recollection of past shots does not count. Pregnancy and a few other clinical situations change the timing, not the requirement itself.

TL;DR:

• Civil surgeons must accurately determine and document Tdap or Td doses based on your age and vaccination history, with no exceptions for verbal reports.
• Overdue boosters more than 10 years old must be administered before completing the form, or your application could face delays or rejection.
• Accurate, written vaccination records are mandatory; verbal histories are not accepted, and missing documentation can cause processing delays.
• For applicants aged 7 to 10, vaccination requirements depend on documented history, with no shortcuts available, requiring review of actual dates.
• Pregnant applicants generally receive a Tdap during weeks 27 to 36, and bringing prenatal records helps coordinate vaccination timing with healthcare providers.

Table of Contents

• What the CDC and USCIS require for tetanus, diphtheria, and pertussis on Form I-693
• Age-based rules: who needs Tdap, Td, or pediatric DTaP
• Pregnancy, contraindications, and wound-management timing
• Documentation rules: what records your civil surgeon will accept
• What happens at the civil surgeon visit
• Common problems, delays, and waiver situations
• How a specialist immigration medical exam clinic reduces errors
• Practical next steps if you are unsure about your Tdap status
• Complete your I-693 vaccination requirements with our clinic
• FAQ
• Sources

What the CDC and USCIS require for tetanus, diphtheria, and pertussis on Form I-693

Civil surgeons do not have discretion to skip the tetanus, diphtheria, and pertussis entry on Form I-693. The CDC’s civil-surgeon vaccination Technical Instructions set the binding standard: every applicant’s vaccination history gets checked against an age-based table, and the civil surgeon records the result directly on Part 10 of the form. The USCIS Policy Manual, Volume 8, Part B, Chapter 9, backs this up from the legal side, treating the vaccination assessment as a required part of the medical exam for adjustment of status.

Two vaccines come up in this context, and they are not interchangeable:

• Tdap (tetanus, diphtheria, and pertussis) is the preferred dose for adolescents and adults who have never had one, since it also protects against pertussis.
• Td (tetanus and diphtheria only) is used for routine 10-year boosters once a person has already had at least one Tdap dose in their lifetime.
• DTaP is the pediatric formulation, used only for children under 7 completing a primary series.

Getting this distinction wrong on the chart is one of the more common paperwork errors civil surgeons catch during review.

The stakes are not just administrative. Under the USCIS Policy Manual, an applicant who is overdue for an age-appropriate Td or Tdap booster, meaning more than 10 years have passed since the last documented dose, is required to receive that booster before the vaccination assessment can be considered complete. Failing to meet this requirement can affect admissibility, since the vaccination record is part of what USCIS reviews when deciding whether to approve the application. This is why civil surgeons tend to treat the tetanus, diphtheria, and pertussis entry as non-negotiable rather than something to work around with a waiver request.

Age-based rules: who needs Tdap, Td, or pediatric DTaP

The vaccine your civil surgeon selects depends almost entirely on your age and your documented history, not on how you feel about getting another shot. Here is how the logic generally breaks down:

1. Age 11 and older with no documented Tdap: You need one dose of Tdap, regardless of how recently you had a Td-only shot.
2. Age 11 and older who already had Tdap: You need Td or Tdap every 10 years from your last documented dose.
3. Ages 7 to 10: Depending on your catch-up vaccination history, you may need a single Tdap dose as part of completing an incomplete primary series.
4. Under age 7: Pediatric DTaP or DT rules apply instead of the adult Tdap/Td schedule, since the immune response and dosing differ for young children.
5. Unknown or incomplete primary series at any eligible age: The catch-up approach generally calls for one Tdap dose, followed by additional Td or Tdap doses roughly 4 weeks later and again at 6 to 12 months, though for the I-693 exam itself, only the next required dose in that sequence is usually needed to complete the assessment.

The 10-year booster rule drives most adult cases. If your last documented tetanus-containing vaccine was more than a decade ago, the USCIS Policy Manual treats you as overdue, and your civil surgeon will need to administer a booster at the visit or document that you received one recently.

The age 7 to 10 group trips people up more than any other bracket. The CDC’s civil-surgeon age table notes that children in this range sometimes need a Tdap dose depending on how their earlier DTaP series went, which means two siblings with slightly different vaccination histories could leave the clinic with different requirements. There is no shortcut here: the civil surgeon has to look at the actual documented dates, not just a general sense of “they’re caught up.”

For applicants who show up with a gap they cannot explain, the practical reality is more forgiving than the full catch-up schedule suggests. Rather than requiring every dose in the multi-month catch-up series before signing off, civil surgeons typically only need to see that the next appropriate dose in the sequence has been given. That single dose, properly documented, is often enough to satisfy the I-693 requirement, with the remaining catch-up doses left for your regular physician to handle on their own timeline.

Pregnancy, contraindications, and wound-management timing

Pregnancy does not exempt you from the Tdap requirement, but it does change when and how the dose gets given. CDC guidance on vaccinating pregnant patients recommends a Tdap dose during each pregnancy, preferably between weeks 27 and 36, to pass pertussis antibodies to the newborn before birth. For the I-693 exam, this creates a timing question your civil surgeon has to resolve case by case.

A few scenarios come up regularly:

• If you are pregnant and already up to date on your routine Td/Tdap schedule, no action may be needed beyond documenting your current status.
• If you are pregnant and not within the recommended 27 to 36 week window for the pregnancy-specific dose, the civil surgeon may document the medical reasoning for deferring the dose rather than giving it immediately.
• In some cases, a Td dose may be given at the exam to satisfy the general booster requirement, with the pregnancy-specific Tdap dose planned for later in the pregnancy through your regular prenatal provider.
• Medical contraindications, such as a documented severe allergic reaction to a previous dose, get recorded in the remarks section rather than overridden.

Wound management follows a separate set of intervals from the routine 10-year booster schedule, since a dirty or severe wound can call for a booster sooner than 10 years if your last dose was more than 5 years prior. This rarely intersects with the I-693 exam directly, but it matters if you mention a recent injury during your visit, since your civil surgeon may factor that into timing decisions.

Pro Tip: If you are pregnant, bring your prenatal records to the exam so your civil surgeon can coordinate the Tdap timing with your obstetric provider instead of guessing at your due date.

Documentation rules: what records your civil surgeon will accept

Written records are the only acceptable evidence for your vaccination history during the I-693 exam. Verbal history, meaning you simply telling the civil surgeon which shots you remember getting, does not count under the CDC Technical Instructions, no matter how confident you are about the dates.

Here is what to bring and how it gets used:

• Original immunization records or certified copies, including school records, military records, or printouts from a previous doctor’s office, with dates clearly listed.
• Translated versions of any foreign-language records, since the civil surgeon needs to read the actual dates and vaccine names to enter them accurately.
• Titer test results, if you have them, which can sometimes substitute for documented doses by showing laboratory evidence of immunity.
• Prior sealed I-693 forms or vaccination supplements, if you had an exam done elsewhere that needs to be referenced or corrected.

On Form I-693 Part 10, your civil surgeon records the specific dates each vaccine was given, marks whether records were transferred from another source, and notes whether your series is complete for each required vaccine. When documentation is genuinely unavailable, the chart is typically marked to reflect that the dose was administered at the visit rather than relying on an unverifiable “VH” for verbal history, since USCIS policy does not accept that as a substitute.

The remarks field carries real weight. This is where your civil surgeon documents contraindications, insufficient time intervals between doses, or the medical reasoning behind a deferred dose during pregnancy. A chart that is missing dates, missing the transferred-records notation, or inconsistent with the vaccine names listed can trigger a request for correction, so accuracy on this page matters just as much as actually getting the shot.

What happens at the civil surgeon visit

The vaccination portion of your I-693 exam follows a fairly predictable sequence, and knowing the steps ahead of time helps you avoid a return trip.

1. Bring photo ID and every vaccination record you have, including anything in a foreign language, since your civil surgeon cannot act on records they cannot read or verify.
2. Your civil surgeon reviews your history against the CDC age-based table and determines which doses, if any, are missing or overdue.
3. Part 10 gets marked with dates given, transferred-record notations, and whether each required series is complete.
4. Missing or overdue doses get administered at the visit when medically appropriate, which is often enough to satisfy the requirement even if your full catch-up series is not finished.
5. The completed Form I-693 is sealed before it is handed to you or sent directly to USCIS, depending on your filing method.

If your tetanus, diphtheria, and pertussis history is incomplete, the practical approach is usually to give you the next required dose in the sequence rather than insisting you complete every dose of a multi-month catch-up schedule before the civil surgeon will sign the form. Later doses in that series, if any remain, can be completed afterward with your own physician on a normal timeline.

One rule matters more than almost any other: do not open the sealed envelope once your civil surgeon hands it to you. USCIS requires the form to arrive sealed, and a tampered envelope can result in the exam being rejected outright, forcing you to pay for and repeat the entire process.

Common problems, delays, and waiver situations

Most I-693 vaccination delays trace back to a handful of avoidable mistakes rather than genuine medical complications.

• Incomplete or illegible vaccination charts, where dates are missing or vaccine names are abbreviated unclearly.
• Wrong vaccine notation, such as marking Td when Tdap was actually required, or vice versa.
• Missing information in other parts of the form, which can hold up the entire I-693 even when the vaccination section itself is correct.
• Opening the sealed envelope before submission, which usually means starting the exam over.
• Relying on verbal history instead of bringing written records, which USCIS guidance does not accept as sufficient documentation.

Blanket waivers exist for situations where a specific vaccine is medically inappropriate for an applicant, such as a documented severe allergy or another contraindication recognized by CDC guidance. In these cases, your civil surgeon documents the medical basis in the remarks section rather than simply leaving the entry blank, since an unexplained gap is treated differently from a properly justified exemption.

If USCIS returns your I-693 or requests additional documentation, the fix usually involves returning to your civil surgeon with the specific records or clarification requested, rather than starting a brand-new exam. Keeping a personal copy of your completed Part 10, as your civil surgeon is required to provide, makes this process considerably faster if a question comes up later.

How a specialist immigration medical exam clinic reduces errors

Since 2007, we have specialized exclusively in immigration medical examinations and Form I-693, with no primary care, urgent care, or sick visits competing for appointment slots or clinical attention. That focus shapes everything about how we handle vaccination assessments.

We offer a simple flat-package approach designed to minimize unexpected costs, with standard I-693 processing available in approximately 3 days and a 2-day expedited option for applicants facing filing deadlines. Vaccines and titer testing happen on-site, so a missing dose or unclear history does not mean a referral elsewhere and another wait.

We frequently see applicants who ran into delays, transcription errors, or incomplete vaccination documentation from exams performed elsewhere. Because accuracy and USCIS compliance are the entire focus of our practice rather than one service among many, our internal quality review is built specifically around catching the kind of Part 10 errors that cause forms to come back.

Practical next steps if you are unsure about your Tdap status

If your vaccination history is uncertain, the smartest move is sorting out the paperwork before you ever sit down with a civil surgeon.

• Collect every written vaccine record you can find, including school, military, or prior doctor documentation, and get translations ready if any are in another language.
• Schedule your exam with a designated civil surgeon rather than a general practice unfamiliar with Form I-693.
• Consider a titer test if your documentation is incomplete or unclear, since it can sometimes clarify your immunity status before the visit.
• If you are pregnant, mention it when scheduling so your civil surgeon can plan the Tdap timing appropriately.
• If records are genuinely missing, expect your civil surgeon to administer the next required dose rather than delay the exam indefinitely.
• Request a personal copy of Part 10 before you leave, and never open the sealed Form I-693 meant for USCIS.

— ImmigrationMedicalExams Medical Team

Complete your I-693 vaccination requirements with our clinic

We handle the full I-693 vaccination assessment under one roof, from reviewing your existing records to administering any missing Tdap or Td dose on-site, so you are not sent elsewhere mid-exam to track down a shot. Our immigration medical exam service covers the civil surgeon review, on-site vaccines, titer testing when needed, and preparation of your sealed Form I-693, all under a flat-package pricing structure.

Standard processing runs approximately 3 days, with a 2-day expedited option available for applicants working against a filing deadline. Appointments can be booked online 24/7, making it straightforward to get your vaccination documentation squared away before it becomes a problem with USCIS.

This article is general information, not a substitute for advice from a qualified doctor. Consult a qualified healthcare professional about your own circumstances before acting on anything here.

FAQ

What vaccines are mandatory for I-693?

Required vaccines depend on your age and documented history, but tetanus, diphtheria, and pertussis protection (Tdap or Td) is required for most applicants age 11 and older under the CDC civil-surgeon Technical Instructions. Your civil surgeon checks your full vaccination history against an age-based table covering several vaccine groups, not just tetanus and pertussis, so the exact list varies by applicant.

Is Tdap required for immigration?

Yes, Tdap or Td is generally required as part of the vaccination assessment on Form I-693 for applicants age 11 and older, based on the USCIS Policy Manual. Applicants overdue for a booster, meaning more than 10 years since their last documented dose, must receive one before the assessment is considered complete.

What are the new rules for Form I-693?

Form I-693 continues to require a civil surgeon to document vaccination history directly on Part 10, following current CDC Technical Instructions, with written records required and verbal history not accepted. The official Form I-693 PDF lays out exactly how transferred records, dates, and remarks should be entered.

Are vaccinations required by law in the United States?

Vaccination requirements for immigration purposes come from federal immigration law and policy rather than general state vaccination laws, and they apply specifically to the adjustment of status medical exam process. The USCIS Policy Manual governs which vaccines are required for Form I-693, separate from any state school or employment vaccination rules.

Sources

• Vaccination | Technical Instructions for Civil Surgeons
• USCIS Policy Manual — Vaccination Requirement (Volume 8, Part B, Chapter 9)