Pneumococcal — Immigration medical exam vaccine
Pneumococcal requirement for Form I-693 USCIS medical exam. Who needs it, doses, cost, side effects, exemptions, blood test alternative. Updated 2026.
Pneumococcal
Required for Form I-693 (USCIS medical exam) for adjustment of status, refugee/asylee status, and certain other immigration benefits.
What it protects against
Streptococcus pneumoniae (pneumonia, meningitis, bloodstream infections).
Who must receive it
Required ages 2–59 months (childhood series) and 65+ years.
Dose schedule
Children: 4 doses PCV15 or PCV20 (2, 4, 6, 12–15 months). Adults 65+: 1 dose PCV20 OR PCV15+PPSV23.
Cost
$0 with Medicare/insurance for adults 65+. Without insurance: $150–$300/dose; FREE for children via VFC.
See Where to get immigration vaccinations for free and low-cost options.
Side effects
Sore arm, mild fever, fatigue. Adults may experience more arm soreness than children.
Blood test alternative (titer)
No — vaccination record required.
Important notes
Adults 19–64 NOT required for I-693 unless certain medical conditions (no spleen, sickle cell, immunocompromise). Most adult immigrants will not need this for the medical exam.
Bring to your civil surgeon
- Yellow international vaccination card (cartilla de vacunacion) if vaccinated abroad
- Pediatrician/clinic records from any US doctor visits
- State immunization registry printout if available
- Translation NOT required for vaccine cards — doses and dates are universal
Civil surgeons can administer missing doses during your I-693 exam, but pricing is typically HIGHER than going to a county health department or pharmacy beforehand.
Related
- Immigration medical exam (Form I-693) overview
- Where to get immigration vaccinations
- Vaccine costs with and without insurance
- Vaccine exemptions and waivers
- I-485 Adjustment of Status
Last verified: 2026-05-25.
General health and procedural information from CDC Civil Surgeon Technical Instructions and USCIS Policy Manual. Not medical or legal advice. Consult your physician for medical guidance and a licensed immigration attorney for case-specific questions.
Related procedural information
- Consulate of your country in the US — passport renewal, consular ID, document apostille
- ITIN — file federal taxes without SSN — required regardless of immigration status
- USCIS form library — federal immigration forms (I-130, I-485, N-400, etc.)
- Find an immigration attorney — pro bono lists + AILA + BIA-recognized
- Know Your Rights — ICE encounters — constitutional protections
USCIS Form I-693 medical exam context (2025-2026)
The USCIS Form I-693 (Report of Immigration Medical Examination and Vaccination Record) is required for adjustment-of-status applicants (Form I-485) and certain refugee/asylee categories. Civil Surgeons designated by USCIS conduct the exam. Find a Civil Surgeon at uscis.gov/tools/find-a-civil-surgeon. Costs range from $100-$500 (with average $200-$350) depending on region — NOT covered by USCIS or any government program.
CDC’s Technical Instructions for Civil Surgeons (most recent major update 2023) specify required vaccinations: tetanus-diphtheria, pertussis (Tdap/DTaP), MMR (measles-mumps-rubella), polio, varicella (chickenpox), influenza (seasonal), pneumococcal (age-dependent), Hib (children), Hepatitis A + B, rotavirus + meningococcal (children), HPV (age 9-26 catch-up). Adults typically need 4-8 vaccines; full pediatric schedule for children. Form I-693 results are valid for 2 years from signature date.
H.R.1 / OBBBA changes (2026-05-29) did NOT affect I-693 procedures, but USCIS Form Fee changes effective 2026-05-29 may affect related adjustment-of-status processing — verify USCIS Fee Schedule at uscis.gov/g-1055 (Form G-1055) before filing I-485. Tuberculosis (TB) screening required for all I-693 applicants 2+ years old; chest X-ray for positive skin/blood tests.
For Civil Surgeon designation questions or vaccination requirement disputes: USCIS Contact Center 1-800-375-5283 Monday-Friday 8:00am-8:00pm Eastern Time. For sealed I-693 transport (DO NOT OPEN — Civil Surgeon places in sealed envelope; USCIS rejects opened envelopes): submit with I-485 or in response to RFE within 60 days. Lost or expired I-693 requires fresh examination ($$$$ again).
For low-cost / free vaccination sources: community health centers (FQHCs at /benefits/community-health-centers-by-state/) provide vaccines on sliding-fee scale; many counties offer free immunization clinics. CDC Vaccines for Children (VFC) program: 1-800-232-4636 (1-800-CDC-INFO) for children whose parents/guardians cannot afford vaccines.
Frequently asked questions
Do I have to get the Pneumococcal vaccine for my green card?
Can I use a blood test instead of getting vaccinated?
How much will this vaccine cost me?
What are the side effects?
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General information, not legal advice. MigrantUSA is an independent publisher and is not a law firm; using this site does not create an attorney-client relationship, and this content is not a substitute for advice from a licensed attorney about your specific situation. US federal, state, and local government procedures, fees, and forms change. Always verify current details directly with the relevant agency before acting. For immigration, tax, or other legal matters specific to your situation, consult a licensed attorney or BIA-accredited representative.