# Two Shots, Same Vaccine Group, Same Day Exception Rules

**Table of Contents**

# Overview

The Two Shots, Same Vaccine Group, Same Day general rule states that if any two vaccines from the same vaccine group are administered on the __ same__ day and both CVX codes would be considered

__(based on minimum age, minimum interval, insufficient antigen, live vaccine interval, etc), ICE will:__

*valid*1.) If both shots are the same CVX code, then evaluate the 1st CVX processed as Valid and evaluate the 2nd CVX processed as Invalid with a reason code of DUPLICATE_SAME_DAY. (This scenario shouldn't happen with most registries.)

2.) If one of those shots is an NOS CVX, then evaluate the NOS as Invalid with a reason code of DUPLICATE_SAME_DAY and evaluate the other (non-NOS) CVX as Valid.

3.) If neither shot is an NOS CVX, if one is a combination vaccine and the other is not a combination vaccine, then evaluate the combination CVX as Valid and evaluate the non-combination CVX as Invalid with a reason code of DUPLICATE_SAME_DAY.

4.) If both shots are an NOS CVX, then evaluate the first CVX processed as Valid and evaluate the second CVX processed as Invalid / DUPLICATE_SAME_DAY.

- EXCEPTION for DTP: if one shot is NOS CVX 107 (a pertussis-containing vaccine) and the other shot is NOS CVX 139 (a non-pertussis containing vaccine), then evaluate the CVX 107 as Valid and evaluate CVX 139 as Invalid with a reason code of DUPLICATE_SAME_DAY.

5.) ** If neither shot is an NOS CVX, neither shot is a combination, or both shots are a combination then:**

- For all vaccine groups EXCEPT for PCV, Hib, Rotavirus, Polio, HepA, DTP, and MMR, evaluate the 1st CVX processed as Valid and evaluate the 2nd CVX processed as Invalid with a reason code of DUPLICATE_SAME_DAY.
**For vaccine groups Hib, Rotavirus, Polio, HepA, DTP, MMR, Pneumococcal, and Meningococcal B,***see the*(Combination vaccines would be evaluated at the component level.)*exception rules below*.

## Hib Exception Rules

- If one of the shots is CVX 49 (Hib OMP), then:
- evaluate the CVX 49 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other Hib CVX as Valid

- If neither shot is CVX 49 (either monovalent or the Hib component), then:
- evaluate the 1st shot processed as Valid
- evaluate the 2nd shot processed as Invalid with a reason code of DUPLICATE_SAME_DAY.
- Examples:
- CVX 46 (ProHIBIT) and CVX 47 (HibTITER)
- CVX 50/TriHiBit (Hib component CVX 48) and CVX 120 (Hib component CVX 48)

## Rotavirus Exception Rules

- If the date of administration is >= 1/1/2000, then:
- If one of the shots is CVX 74 (rotavirus, tetravalent), then:
- evaluate CVX 74 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other rotavirus CVX as Valid

- If neither shot is CVX 74 and one of the shots is CVX 119 (rotavirus, monovalent), then:
- evaluate the CVX 119 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other rotavirus CVX as Valid

- If one of the shots is CVX 74 (rotavirus, tetravalent), then:
- If the date of administration is < 1/1/2000, then:
- If one of the shots is CVX 74, then:
- evaluate CVX 74 as Valid
- evaluate the other rotavirus CVX as Invalid with a reason code of DUPLICATE_SAME_DAY

- If neither shot is CVX 74 and one of the shots is CVX 119, then:
- evaluate the CVX 119 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other rotavirus CVX as Valid

- If one of the shots is CVX 74, then:

## Polio Exception Rules

- If one of the shots is CVX 02 (OPV), then:
- evaluate the CVX 02 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other polio CVX as Valid

- If neither shot is CVX 02, then:
- evaluate the 1st shot processed as Valid
- evaluate the 2nd shot processed as Invalid with a reason code of DUPLICATE_SAME_DAY
- Example: CVX 120/Pentacel (Polio component CVX 10) and CVX 130/Kinrix (Polio component CVX 10)

## Hep A Exception Rules

- If the patient is >= 19 years at the time of administration, if one of the shots is CVX 83 or CVX 84 (pediatric formulations), then:
- evaluate the CVX 83/CVX 84 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the CVX 52 (Hep A adult) as Valid

- If the patient < 19 at the time of administration, if one of the shots is CVX 52 (Hep A adult), then:
- evaluate the CVX 52 as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate the other Hep A CVX (pediatric formulation) as Valid

- If CVX 83 and CVX 84 are administered on the same day, then:
- evaluate the 1st shot processed as Valid
- evaluate the 2nd shot processed as Invalid with a reason code of DUPLICATE_SAME_DAY

## DTP Exception Rules

- If one of the shots is a pertussis-containing vaccine (CVX 01, 20, 106, or 115) and the other shot is a vaccine that does not contain pertussis (CVX 09, 28, 113, or 138), then:
- evaluate the shot that contains pertussis (CVX 01, 20, 106, or 115) as Valid
- evaluate the shot that does not contain pertussis (CVX 09, 28, 113, or 138) as Invalid with a reason code of DUPLICATE_SAME_DAY

- If neither shot contains pertussis or both shots contain pertussis, then:
- evaluate the 1st shot processed as Valid
- evaluate the 2nd shot processed as Invalid with a reason code of DUPLICATE_SAME_DAY

## MMR Exception Rules

- If CVX 94 (MMR-Varicella) is administered on the same day as another CVX code from the MMR group, then:
- Evaluate CVX 94 (MMR-Varicella) as Valid and evaluate the other CVX code within the MMR group as Invalid with a reason code of DUPLICATE_SAME_DAY
- Otherwise:
- If CVX 03 (MMR) is administered on the same day as another CVX code from the MMR group EXCEPT for CVX 94 (MMR-Varicella), then:
- Evaluate CVX 03 (MMR) as Valid and evaluate the other CVX code within the MMR group as Invalid with a reason code of DUPLICATE_SAME_DAY

- If CVX 03 (MMR) is administered on the same day as another CVX code from the MMR group EXCEPT for CVX 94 (MMR-Varicella), then:

**The following CVX codes can be administered on the same day. If administered on the same day, then they should be evaluated as Valid or Invalid based on minimum age / minimum interval from the last shot given on a previous day. They SHOULD NOT be evaluated as Invalid / DUPLICATE_SAME_DAY.**- 05 – Measles
- 06 – Rubella
- 07 – Mumps

- If one of the multiple component vaccines in the MMR group, i.e., CVX code 04 (Measles/Rubella) or CVX code 38 (Mumps/Rubella), is administered on the same day as one of the single component vaccines (i.e., CVX 05, CVX 06, or CVX 07), then each shot should be evaluated as Valid or Invalid based on minimum age/minimum interval from the last shot given on a previous day. They SHOULD NOT be evaluated as Invalid/DUPLICATE_SAME_DAY. However, only one of the duplicate components should count toward series completion.
- If both of the multiple component vaccines in the MMR group, i.e., CVX code 04 (Measles/Rubella) or CVX code 38 (Mumps/Rubella), are administered on the same day, then they should be evaluated as Valid or Invalid based on minimum age / minimum interval from the last shot given on a previous day. They SHOULD NOT be evaluated as Invalid/DUPLICATE_SAME_DAY. However, only one of the duplicate components should count toward series completion.

## Pneumococcal Exception Rules

- If CVX 133 (PCV 13) and CVX 100 (PCV 7) are reported as administered on the same day, then:
- If the shot was administered < 6/1/2010, then:
- evaluate CVX 133 (PCV 13) as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate CVX 100 (PCV 7) as Valid

- If the shot was administered >= 6/1/2010, then:
- evaluate CVX 100 (PCV 7) as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate CVX 133 (PCV 13) as Valid

- If the shot was administered < 6/1/2010, then:
- If CVX 216 (PCV20) dose and any other Pneumococcal vaccine is reported as administered on the same day, then:
- evaluate CVX 216 (PCV20) as Valid
- evaluate the other Pneumococcal vaccine as Accepted/ EXTRA_DOSE

- If CVX 215 (PCV15) dose and CVX 133 (PCV13) are reported as administered on the same day, then:
- evaluate CVX 215 (PCV15) as Valid
- evaluate CVX 133 (PCV13) as Invalid with a reason code of DUPLICATE_SAME_DAY

## Meningococcal B Exception Rules

- If CVX 162 (Meningococcal B FHbp, recombinant (Trumenba)) or CVX 316 (Meningococcal MenABCWY (Penbraya)) and CVX 163 (Meningococcal B 4C, OMV (Bexsero)) are reported as administered on the same day, then:
- evaluate CVX 162 (Meningococcal B FHbp, recombinant (Trumenba)) or CVX 316 (Meningococcal MenABCWY (Penbraya)) as Invalid with a reason code of DUPLICATE_SAME_DAY
- evaluate CVX 163 (Meningococcal B 4C, OMV (Bexsero)) as Valid
- recommend based on the MenB 4C 2-dose Series.

However, if both Meningococcal B vaccines are administered on the same day, and one vaccine would complete a Meningococcal B series, then evaluate that vaccine as Valid and the other Meningococcal B vaccine as Invalid with a reason code of DUPLICATE_SAME_DAY. *(Example - CVX 162 (Trumenba) or CVX 316 (Meningococcal MenABCWY (Penbraya)) administered at 16 years old. CVX 162 (Trumenba) or CVX 316 (Meningococcal MenABCWY (Penbraya)) and CVX 163 (Bexsero) administered on same day (at 16 years, 6 months old). Trumenba 2-dose series applies/Series Complete. CVX 163 would be evaluated as Invalid/DUPLICATE_SAME_DAY.)*