I-693 vaccination record question

[mlrivers 0]

Hello,

I have a question on the I-693 vaccination record form that I could use some advice on. My wife came here from the Philippines on a K-1 visa in October, 2012 and we got married in December, 2012. We went through the process of assembling all information needed for the AOS and sent it in at the end of January, 2013. When she arrived, she had a DS-3025 vaccination worksheet given to her by the medical center in the Philippines where she had her physical exam, which indicated that her vaccinations weren't complete. The physician at the medical center had told her which vaccine she needed to get a booster/2nd administering of. In January, we went to a local clinic that could do Civil Surgeon services, and explained to them that we only needed to have the vaccination record updated on the I-693, and that she needed at least one vaccine administered.

To make a long story short, the DS-3025 had the Td/Tdap vaccine noted as "insufficient time interval" and the physician in the Philippines had told my wife that was what she need a 2nd dose of. The doctor at the local clinic we went to somehow read the worksheet as my wife needing a 2nd MMR shot. We questioned this, but the doctor insisted she needed the MMR shot. We ultimately went along, figuring the doctor should know what she's doing. So, she received a 2nd MMR vaccine (which made her feel bad for about a week), and the doctor filled out a I-693 to give to us. The problem was, the doctor refused to put the I-693 in a sealed envelope, telling us she wouldn't do it since my wife didn't have the complete physical that is the normal part of the I-693. Again, we tried to convince her that it needed to be sealed but weren't successful. To be honest, I wasn't sure how important it was for the results to be sealed for just the vaccine history.

After doing some more reading, including here at VisaJourney, we ended up deciding not to send in the unsealed I-693 with the AOS package, thinking maybe her vaccination history was OK. A few days ago, however, we did receive a RFE indicating that the vaccine documentation is incomplete and that we must send in an I-693 and get any vaccinations necessary to complete it. So, we decided to go back to the same local clinic again (since other doctors that are identified as Civil Surgeons don't seem to understand that only part of the I-693 has to be done and only want to do complete physicals and refuse to even consider anything else; at least this clinic was willing to do only the vaccination parts of the form) and try to get this resolved. This time, the people there were very accommodating, but curiously, they looked over the worksheet and concluded she needed a 2nd MMR shot as well. I was able to prove to them that my wife had had that 2nd MMR shot in January, 2013 at that same clinic, so they offered to re-do the I-683 and provide a correct sealed envelope this time. That was great. So after an hour of waiting, we walked out with a sealed envelope with the I-683 and another copy for our records.

When we got home, later that night, I looked at the I-683 copy and was comparing it to the DS-3025 copy we have and noticed some problems. For one, they transcribed one of the vaccinations wrong: the DS-3025 has my wife receiving a Tdap shot, but they checked off the Td shot box on the I-693. And they never did administer a 2nd Td/Tdap shot like we think she needed and what the original DS-3025 seemed to say; they just marked it off as "complete." So my question/concern is, should we send in this sealed version of the I-683 to satisfy the RFE? They checked off the "vaccine history complete" box so that should count for something, right? How closely do they scrutinize the details of the vaccinations compared to the DS-3025? If we sent it in and they noticed these discrepancies too, would any blame or judgement be passed? I can't see it being our fault that the Civil Surgeon screwed up the transcription (if it even matters for the Td/Tdap) or the final assessment of "vaccine history complete," but don't want to risk having any penalties being brought against us as a result if they think we're trying to deceive them. The doctors are the experts and we should be able to trust that they know what they're doing and not have to even understand how to read/interpret the worksheets. That's why it has to be at a Civil Surgeon, who presumably went through training/certification to do this. Should I just try again to get the I-683 filled out correctly or send in what I have and see if they accept it? This is getting very frustrating trying to get the right thing done.

Thanks in advance!

[Stevephoto 230]

Joan and I went to our doctor yesterday for a flu shot and we showed him Joan's vaccination form. He said that we were up to date. Two boxes were checked "insufficient time interval (tdap and varicella) but our doctor said NO need for boosters! It is hard to tell who to believe, but I trust our doctor.

Edited September 1, 2013 by Stevephoto

[DavenRoxy 1,073]

I'm not at home right now, and can't check her DS-3025, but I remember it was missing some stuff. Steve, can you check and see what was missing for me?

At any rate, all we sent in was the DS-3025, and were approved. Might tell more of the story once we know what was missing.

[Nich-Nick 3,354]

Mirivers--Can you post a scan or photo of your DS-3025?

[mlrivers 0]

Sorry for the delay, I was out of town. A redacted and resized scan of her DS-3025 is attached. Thanks for your help.

Mark

[Nich-Nick 3,354]

Sorry for the delay, I was out of town. A redacted and resized scan of her DS-3025 is attached. Thanks for your help.

Mark

I guess you redacted the doctor's signature?? Because that would be a RFE.

What I see wrong is MMR is a two dose shot. This has one shot, so in order to skip Dose2, the waiver column for insufficient time interval should have been marked. I think the panel physician mixed up the shots because Tdap one dose should have been fine because it only has to be in the last ten years, which it was.

When you went to the civil surgeon, the time interval of four weeks since the MMR was given had passed. So it was correct to give another MMR.

[h13rma 35]

Must be in an unopened sealed packet or it will not be accepted. Your civil surgeon must be on the list and should know how to fill out the paper work.

[mlrivers 0]

I guess you redacted the doctor's signature?? Because that would be a RFE.

What I see wrong is MMR is a two dose shot. This has one shot, so in order to skip Dose2, the waiver column for insufficient time interval should have been marked. I think the panel physician mixed up the shots because Tdap one dose should have been fine because it only has to be in the last ten years, which it was.

When you went to the civil surgeon, the time interval of four weeks since the MMR was given had passed. So it was correct to give another MMR.

Yes, I redacted the doctor's signature; it was present. The RFE is specifically for a vaccine being listed as having "insufficient time interval" marked, which I presume, according to the DS-3025 is the Td/Tdap shot.

Based on what you're saying, it sounds like the civil surgeon did fill out the I-693 report correctly in January and gave her the correct MMR at that time (but would not put it in a sealed envelope). Is it OK then that the civil surgeon transcribed the Tdap wrong and checked the Td vaccine on the I-693 instead, or does that not matter as long as one kind has been administered? Is it also OK that the Td/Tdap went from "insufficient time interval" to "complete" with no other changes/evidence of additional shots, etc? Thanks again for your advice!

Mark

[Nich-Nick 3,354]

I don't know the exact wording of your RFE so don't have a comment on your description of it.

If you send an I-693, then it becomes the new document of record and the other no longer counts.

I do agree with what the civil surgeon did on the shots based on my research and understanding. The latest version of the I-693 is poorly constructed and a number of doctors don't want to sign it because it appears that by signing, they are also agreeing that they gave you a full exam.

[DavenRoxy 1,073]

I guess you redacted the doctor's signature?? Because that would be a RFE.

What I see wrong is MMR is a two dose shot. This has one shot, so in order to skip Dose2, the waiver column for insufficient time interval should have been marked. I think the panel physician mixed up the shots because Tdap one dose should have been fine because it only has to be in the last ten years, which it was.

When you went to the civil surgeon, the time interval of four weeks since the MMR was given had passed. So it was correct to give another MMR.

MMR is not a 4-week interval shot. It is normally given to children around 1 year old, and then again as a booster just prior to school (to cover the potential 2-5% of kids who may have failed to develop immunity).

It is considered a childhood vaccine, though some adults with HIV are also recommended to receive it. I guess without proof of having it as a child, immigrants are required to get it also, but not a multi-dose vaccine.

My wife's 3025 looks similar to yours. I'll try to upload it so you can see.

Me thinks your CS screwed up...

ETA: Tdap (adult version of childhood DTaP) is normally given every 10 years, but due to tetanus toxoid reactions, it is not normally given in intervals under 5 years except in specific cases.

Edited September 3, 2013 by DavenRoxy

[Nich-Nick 3,354]

The ACIP recommends two doses of MMR. If the immigrant had a record of shots at ages 1 and 5, then the dates would be written on the form and nothing further would be needed. Series complete.

In the case of the OP, there is one dose documented. So then the question of Dose 2 needs to be considered because the series is not complete. If at least 28 days had passed since Dose 1, another dose could be safely administered. In this case zero days had passed so a waiver reason could be marked as "insufficient time interval". It would not be medically appropriate to get the seco d dose on that day.

I did't mean to imply that all MMRs are given 4 weeks apart, but that it has been determined that doses should not be given any closer together than 28 days if one is playing catch-up as an adult or lacks a childhood proof of immunizations.

Edited September 3, 2013 by Nich-Nick

[DavenRoxy 1,073]

Well, I'm not familiar with a second dose of MMR for adults, is why I posted what I did above. My wife had the same single MMR as the OP, sent in her DS-3025, and never got another shot nor RFE. Either we got lucky, or the person reviewing their file doesn't know what the deal is.

Just checked the CDC, and as I said, a second MMR shot should not be required. According to the CDC, from age 19-55, a person needs "1 or 2 doses". Note 7 says:

"All adults born in 1957 or later should have documentation of 1 or more doses of MMR vaccine unless they have a medical contraindication to the vaccine, or laboratory evidence of immunity to each of the three diseases."

From that, it appears to me that 1 dose of MMR should be sufficient, but more would not hurt. But to know for sure, we need to know the exact wording of the RFE to see why.

[mlrivers 0]

Interesting, so DavenRoxy, you're saying you didn't need an I-683 and received no RFE regarding the DS-3025? The RFE we received doesn't give specifics of what vaccine is incomplete other than that it does specifically say it is due to a vaccine being marked as "insufficient time interval" during the initial medical exam (if you wish to see the exact document, I can scan it). I concluded that is the Tdap, since that is the only vaccine that is marked on my wife's DS-3025 (see my earlier post with attached scan) in that column. It's hard to say what that means based on your experience.

I think from what you and Nich-Nick have said, my I-683 should be fine, as it has evidence of 2 MMRs administered and all other applicable vaccinations are marked as completed and the overall "vaccinations complete" checked. Most importantly, it's in a sealed envelope this time! I will send in what I have and hope to not get any RFEs back for it.

Thanks a lot for your advice!

Mark

[DavenRoxy 1,073]

Yes, we used the DS-3025 only, as you see it here. No second MMR, and no issues with the Tdap. 2nd MMR is not a requirement, and Tdap is a 10-year interval, so I'm unsure why the SLEC doc(s) are checking "insufficient time interval".

[Nich-Nick 3,354]

And London panel physicians are requiring a second MMR if the time interval is not too soon. If they give the "insufficient time interval" reason for waiver, they write by the check mark a due date and tell the people when the second shot is due. And they write at the bottom in notes that a second MMR is needed.